Immunisation & Vaccination Record Immunisation & Vaccination Policy All students undertaking a health care qualification with

a clinical/work experience placement are required to ensure their immunisations are up to date. As a condition of placement: all students are required to provide an up to date immunisation record to staff at their allocated placement venue before they can begin their cliniubmitting all required documentation. Vaccinations/Serology Required Vaccinations/Serology are required for each of the following diseases: Diphetiera, Tetanus, Pertussis (Whooping Cough) Hepatitis B Measles, Mumps, Rubella (MMR) Varicella (Chickenpox) Tuberculosis (TB) Influenza (not required but highly recommended) Evidence Required for Vaccination/Immunity For each disease requiring evidence of vaccination, please provide at least 1 of the following: Documentation on an Adult Vaccination Card (AVC) or immunisation card equivalent A statement from a GP Practice on the Practice letter head Overseas/interstate vaccination records. Information provided must include: Date Batch number Vaccine brand name Signature of immunisation provider Practice or Provider stamp Or a combination of three of these details. Part of the Navitas Group Page 1/5 0128-1013 Page 2/5 0128-1013 Immunisation & Vaccination Record Evidence of Serology (Blood Tests/Pathology) For each disease requiring evidence of serology (blood tests), provide at least 1 of the following: Pathology results on a Pathology Service letterhead. A statement from a GP Practice on the Practice letterhead (written results including result value signed by your GP). To Provide Evidence of Your Immunity 1. Please attach a copy of your immunisation records or evidence of immunity with the following form. 2. Alternatively, take this documentation with you to your General Practitioner (GP) when requesting vaccination and serology to ensure they provide the correct documents required. 3. Records of vaccinations and proof of immunity that were received from overseas must be in English (translations must be certified) and contain enough information about the vaccine (e.g. brand, active components and batch numbers if available) and vaccination dates to enable an assessor to determine if they fulfill the requirements. Page 3/5 0128-1013 Immunisation & Vaccination Record Students details: Full name:

Date of birth: Phone: Email: Gender: Female Male Vaccination/Serology Required Diphtheria, Tetanus, Pertussis (Whooping Cough) Evidence Required Date Achieved Vaccination: One adult dose of Diphtheria/Tetanus/Pertussis vaccine (dTpa). Note: All three diseases must be covered. ADT vaccine does not cover you for Pertussis and you will be required to have a repeat vaccine with Adacel or Boostrix. Vaccination / / Hepatitis B Evidence Required Date Achieved Vaccinations: Documented evidence of a completed, age appropriate course of hepatitis B vaccination i.e. if vaccinated as an Vaccinations / / Note: Where there is a history of vaccination and Anti-HBS >=10 but no documentation, it is reasonable to accept that they have been vaccinated as per the appropriate schedule. This may be accepted as compliant. Serology: This is required in addition to Hepatitis B vaccination. The aim is to have Anti-HBS >= 10m/U/ml, OR Documented evidence of Anti-HBC, indicating past Hepatitis B infection. Serology / / Note: If Anti-HBC is positive (indicating a past Hepatitis B infection) additional investigation may be required. Serology Yes No Follow up required? Yes No Page 4/5 0128-1013 Immunisation & Vaccination Record Measles, Mumps, Rubella (MMR) Evidence Required Date Achieved Vaccination: 2 doses of MMR vaccine at least one month apart, or a Vaccination/Booster / / Serology: Positive IgG for measles Serology / / Positive IgG for mumps Serology / / Positive IgG for rubella Serology / / Varicella (Chickenpox) Evidence Required Date Achieved Vaccinations: 2 doses of varicella vaccine at least one month apart, or a booster. Vaccinations / / Serology: Positive for varicella. Serology / / Immunisation & Vaccination Record Medical Condition/Disability History All students must complete and submit the following medical history or disability report prior to

being able to attend their first placement. You may be asked to undertake vaccination at your own cost. Please complete and return the form with your documents on Enrolment & Orientation Day or to the Student Services Coordinator at your campus once you have obtained these. Your full name: 1. Please indicate if you have a current medical condition/s. Yes No 2. Please indicate if you have a disability. Yes No 3. If Yes to 1 or 2 above, please provide details of medical condition/disability: 4. Do you use aids to assist you with your medical condition/disability? Yes No If Yes, please provide details. Declaration I hereby declare that all the information provided in this questionnaire is correct and true and I acknowledge complete responsibility for such, whether written by me or another person authorised on my behalf. Signature: Date: Signature: Date: