Accurate entries are required for HSPnet reporting.
Please enter your legal name is it appears in your student records.
All items and tasks must be complete prior to your practicum start date.

Note: This form can be completed in multiple sittings. To save, please ensure a valid email is entered, and then scroll to the bottom of the page and hit the "save" button. 

This form has been created by Staff Development/Infection Prevention and Control for Southern Health-Santé Sud and has been regionally approved for use.
Creator: Staff Development/IPC
Owner: Student Placement Coordinators
Date Created: August 2025

Please review all of the below information and initial after each section has been accessed and is complete.
When you have completed this checklist and gathered all required documentation as described below press the submit button to email your checklist, attaching all required documents, to Student Placement.
If some items will be sent separately please clearly indicate same in the comments section.
Any questions or requests for clarification can be directed to the Receiving Coordinators (contact information at the end of page 2).

All items and tasks must be complete prior to your practicum start date.

This form may be filled either digitally or printed & scanned.

A witness must sign the form. This may be your instructor, practicum coordinator, or (if you are a current employee): your manager. 

To Complete this form Digitally

Using the ... button on the top left of the above PDF, click the "Save" button.

Sign digitally by using Adobe Acrobat / Microsoft Edge / Google Chrome

To Complete this form in Hard Copy (Print)

Requires: Printer, Scanner, Pen

Using the ... button on the top left of the above PDF, click the "Print" button. This should open the pop-up where you can print the sheet.

Fill the form, and scan the paper. Submit the scanned form to the file submission below.

How to access LMS PHIA for Health Care

NOTE: The following only applies to students without a pre-existing LMS account. Those with pre-existing accounts should login to their account and download the certificate.

1. Go to the LMS Login Page.
   Note: pop-up blockers must be turned off
   • Login: 
     • username: casual.employee 
     • password: password123
2. PHIA – Instructions to complete online PHIA training using the casual employee/students LMS account (no tracking, requires manual pledge). Turn off your pop-up blockers.
3. Select Learning History and click Launch next to the PHIA for Health Care – Manual Pledge.
4. Once completed, print a copy of your screen or take a picture of your signed Declaration of Confidentiality form, to submit to the file submission below.
   Note: It is recommended that the course be completed in one sitting, as it will always start again from the beginning when launched from the History tab.

Link to LMS Login Page

 

Instructions to return to Checklist from Link
If you click a link within the checklist, it will open a new tab in the browser. This action will send the checklist tab to the background. To return, navigate to the top of the browser window and click on the "Student Checklist" tab.

Link to Facility Orientation (3.5 hours)

Instructions to return to Checklist from Link
If you click a link within the checklist, it will open a new tab in the browser. This action will send the checklist tab to the background. To return, navigate to the top of the browser window and click on the "Student Checklist" tab.

At the final page, there will be a link taking you to next part of your orientation called "Facility Orientation Interactive Maps and Specific Site Information".

Here, you should find your site that you will be doing your practicum on (or the Affiliate site tab, if you do not see your site). Read through the page as normal, and when complete, hit the "complete sign-in" button.

This will take you to a final page with a Microsoft Form. Ensure it is completed, or you will not receive credit.

Knowledge Check

• Enter "Employee ID" as STUDENT
• Enter "Base Work Site/Program" as Regional Payroll
• Enter "Position Title" as Student

This section is NOT required by Paramedic (PCP) students.

Safe Patient Handling Program (SPHP) (Previously known as SCHIPP) is required for all new HCA and Nursing students. If this training has not been received in your classroom you may attend an individual session either prior to, or upon commencement of, your practicum.

Senior Nursing Practicum students ONLY (Does not include HCA's).

Regional Clinical Orientation (RCO) is a two-day orientation presented at our three regional centres: Bethesda Regional Health Centre, Boundary Trails Health Centre, and Portage District General Hospital. RCO is required for all new nurse hires within our RHA, and students are strongly encouraged to attend. RCO helps prepare nursing students for their roles as part of the Southern Health-Santé Sud team. Unless you indicate that you have previously attended RCO it will be included in your Senior Practicum Schedule.