CHECKLIST FOR VERIFICATION APPOINTMENT

□ Original and photocopy of education provider-issued student photo ID card

□ Original and photocopy of current Police Check from Australia (in exactly

the same name as student photo ID card) and

□ Original and copy of overseas Police Check OR statutory declaration

stating no charges or convictions in country of origin for international

students only

□ Original and copy of Clinical Placement Card if any disclosable

outcomes on police check

□ Original and copy of signed Code of Conduct for NSW Health

□ Attachment 6 Undertaking/Declaration form AND originals with copies of

documented evidence of vaccinations and serology records (printed blood

test results) as follows:

□ dTPa (diphtheria, tetanus, pertussis) – at least one documented dose

in last 10 years

□ MMR (measles, mumps, rubella) – 2 documented doses at least one

month apart OR positive serology for measles mumps and rubella OR

born before 1966

□ Varicella – 2 documented doses at least one month apart OR 1 dose

of varicella received before age 14 OR positive serology for varicella

□ Hepatitis B – at least first dose documented for temporary

compliance only OR completed full age appropriate course AND

positive serology taken at least 4 weeks after last dose for full

compliance (if all attempts fail to obtain documented evidence of full

age appropriate course of Hepatitis B vaccination, then fully

completed statutory declaration AND positive serology result may be

presented) Note: Hepatitis B compliance pathway is attached

□ Attachment 7 – Tuberculosis risk form – A completed risk assessment form

will be required for this assessment. No further screening tests are

required prior to this session. Those students needing further screening will

be advised of their follow up plan and can be made temporarily compliant.

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