Concise Health Solutions Pre placement Clearance Review Form
Please complete this form and upload your required documents, then click the Submit button. Concise Health Solutions will review your documents and will send you a Summary Report stating that you are CLEAR for placement. If you have not uploaded all of your required documents, Concise Health Solutions will send you a Summary Report stating that you are NOT CLEAR. You will be advised of the missing documents which will need to be completed in order to be CLEAR. Once you have completed your missing documents you will need to book a RETURN CLEARANCE REVIEW appointment. **YOUR DOCUMENTS WILL NOT BE REVIEWED IF YOU HAVE UPLOADED THEM LATE**
Name
*
First Name
Last Name
Student Number
*
School Email
*
Example - student@queensu.ca, student@myseneca.ca, student@georgebrown.ca
Which Program?
*
Seneca Nursing
Seneca PSW
Seneca Veterinary
Seneca Medical Device Reprocessing
Seneca Therapeutic Recreation
Seneca OTA/PTA
Queen's Nursing
Queen's Nurse Practitioner
Campus
*
King
Newnham
Kingston (Queen's University)
What placement are you clearing for?
*
Fall Placement
Winter Placement
Spring Placement
Summer Placement
What Year Are You In?
*
1st Year
2nd Year
3rd Year
4th Year
5th Year
What Semester Are You In?
*
What is your placement start date?
*
-
Month
-
Day
Year
Date
What is your placement end date?
*
-
Month
-
Day
Year
Date
If Nursing, What Program?
*
220
520
320
420
PND
PNC
PNC520
TNC
BScN
BScN AST 3
BScN AST 4
If you are a Veterinary Student, what program?
*
Veterinary Technician
Veterinary Assistant
If you are a Seneca Esthetics Student, what program?
*
EST
MST
What GBC ECE Program?
*
C100
C118
C130
C140
C148
C160
C300
C301
Are you a full-time student?
*
Yes
No
Are You an International Student?
*
Yes
No
If you are a International Student upload your International Co-Op Work Permit
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Upload Your VSS Document
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Make sure you include the password to the document!
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What is your VSS password?
If there is no password, leave this blank.
Upload Your Standard First Aid CPR-C Certification
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Upload your BLS certification
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Upload your WHMIS certification
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Authorization to Collect and Disclose Personal Information Field Placement
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Upload your Health & Safety Certificate
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Upload your WSIB Student Declaration letter
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Upload your Student Consent forms
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Upload your Medical Form
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This is the form you have downloaded from our website that contains your medical information like TB Mantoux Skin Test, MMR, Hep B, Varicella, Polio, T/D/P etc.
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Upload your lab reports
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Upload your Chest X-ray report if you are TB positive
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Upload your Doctor Note stating that you are “free of signs and symptoms of active TB” if you are TB positive
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Upload your flu shot documentation
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Only for students clearing for Fall/Winter. Flu shots will be available in October
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Upload your Covid-19 vaccine documentation
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Upload your Mask Fit test
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Upload Proof of Rabies Vaccination
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Upload Your Rabies Serology Report
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Upload Your Queen’s University Immunization Record & Serologic Status Form
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Upload Your Annex A,B,C
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Upload Your Hspnet Consent Form
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Upload Your AODA Training
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Upload Your KHSC Learning Placement Authorization Form
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Upload Your WSIB Declaration Form
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Upload Your Infection Control & Prevention Training
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Upload Your Updated Curriculum Vitae (CV)
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Upload Your Annex D (confirmation email as proof of completion)
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Upload your NVCI card
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If you are missing any documents, what are they?
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Should be Empty: