2021 NSW Vaccination Record Card Completion Guide 11 August 2021 Page 1 of 6

NSW STUDENT VACCINATION RECORD CARD COMPLETION GUIDE

Vaccination Requirements for Professional Experience Placement (PEP) within NSW Health and Private Health Care Agencies

The University of Tasmania is required to comply with Commonwealth and State legislation and regulations to ensure the safety of students and healthcare consumers. The College of Health and Medicine has a duty of care towards both students and healthcare consumers to prevent or minimise the risk of transmission of infectious or blood-borne diseases.

All vaccinations, screening and serology reports MUST be documented on the NSW Health Vaccination Record Card for Health Care Workers and Students to enable you to comply with both the College of Health and Medicine & NSW Health- Occupational Assessment, Screening and Vaccination against Specified Infectious Diseases Policy (PD2020_17) for students undertaking PEP in NSW health care agencies.

The NSW Health Vaccination Record Card for Health Care Workers and Students is available from the NSW PEP Team. Students are responsible for all costs associated with completing their vaccination compliance. Attached to this completion guide is a sample NSW Health Vaccination Record Card for Health Care Workers and Students. It is recommended that you take this guide to your GP with your Vaccination Record Card.

It is a NSW Health requirement that only a GP or an Authorised Nurse Immuniser can complete the Vaccination Record Card for Health Care Workers and Students. A clinic/practice stamp, practitioner name and signature is required next to each individual entry on the Vaccination Record Card. All vaccination and serology entries on the Vaccination Record Card must be legible and in English.

Prior to visiting your GP, please check the following sources for your vaccination records: child health records/baby books, vaccination/travel clinics, staff health records and GP medical records. Students previously immunised in Australia can also download their immunisation history from the Australian Immunisation Register, also known as the Medicare Immunisation Statement.

Please start the vaccination compliance process as soon as possible as it may take up to 8 or 9 months to complete the process. Once you have seen your GP and they have commenced your Vaccination Record Card you are required to:

• Scan your Vaccination Record Card and serology/screening reports into a single PDF and upload to InPlace for verification by the NSW Authorised Nurse Immuniser after each individual vaccination (if required) for verification during the Semester and at other times as requested. Once you have completed all vaccination/serology/screening requirements, your Vaccination Record Card needs to be scanned into a single PDF and uploaded to InPlace for final verification.

2021 NSW Vaccination Record Card Completion Guide 11 August 2021 Page 2 of 6

• Take your Vaccination Record Card with you on 1st day of PEP to all PrivateHealth Care Agencies

If you do not upload your Vaccination Record Card to InPlace and/or submit allother compliance documents to your PEP Coordinator/NSW Authorised NurseImmuniser by the end of Semester you may not be eligible to undertake PEP asscheduled.

Further information regarding Vaccine Preventable Diseases is available from theCollege of Health and Medicine Compliance WebpageTo upload your Vaccination Record Card into InPlace:

Login to InPlace: https://inplace.utas.edu.au/

- click ‘Staff and Students’- Your username is your University email address, i.e.

student123@utas.edu.auYour password is the same for all University accounts, i.e. MyLO, eStudent and Webmail

NSW Health Vaccination Record Card for Health Care Workers and Students Completion Instructions

Disease Vaccination Record Card entry must include

Diphtheria, Tetanus and Pertussis

One adult dose of dTpa vaccine given within the last 10 years Documented on Vaccination Card including

• Date of administration AND• Batch number (if no batch number provided, an adult dTpa booster will be

required) AND• Health care provider signature AND health care provider practice stamp• No serology results are accepted. Do not use ADT vaccine OR• A dTpa vaccine recorded on your Medicare Immunisation Statement

Hepatitis B

History of a completed age appropriate course of Hep B vaccinations OR • If a student has been vaccinated but cannot locate their Hep B vaccination

records, a verbal history of Hep B vaccinations must be recorded on theVac Card by your GP/ Authorised Nurse Immuniser with the health careproviders sianture and practice stamp AND a NSW Health Appendix 9Hepatitis B Vaccination Declaration must be completed and witnessed by aGP/ Authorised Nurse Immuniser. This Vaccination Declaration mustalways accompany the Vac CardAND

• Hep B surface antibody serology. The result must only be recorded as anumerical value. ≥ 10 IU/ml equals immunity. Please note: ‘positive’,‘immune’ or ‘detected’ are not accepted ORDocumented evidence of anti HBc, indicating past Hepatitis B infection

• If after three (3) Hepatitis B vaccinations your Hep B surfaceAntibody serology is below 10IU/ml, please contact NSW PEP teamASAP for further information, as further Hep B vaccinations andserology will be required.

2021 NSW Vaccination Record Card Completion Guide 11 August 2021 Page 3 of 6

• All Hep B vaccinations must be documented on Vaccination Card including• Date of administration AND• Batch number if given within last two (2) years AND• Health care provider signature AND• Health care provider practice stamp

Measles, Mumps, Rubella

Evidence of two (2) MMR vaccinations, administered at least one month apart and documented on the Vac Card including

• Date of administration AND• Batch number if given within last two (2) years AND• Health care provider signature AND• Health care provider practice stamp OR

• Serology result indicating positive IgG for Measles and Mumps and Rubella,AND

• Rubella serology result must be recorded on the Vac Card as a numericalvalue ONLY. Please note: ‘positive’, ‘immune’ or ‘detected’ are notaccepted) AND

• Rubella serology report must also be included with the Vac Card as 1 pdfdocument.

• All MMR serology results must be documented on the Vaccination Cardincluding date of serology, health care provider signature and health careprovider practice stamp OR

• Born prior to 1966Varicella Evidence of an age appropriate course of vaccination:

• If vaccinated at under 14 years old, evidence of one (1) Varicellavaccination.

• If vaccinated at 14 years or older, evidence of two (2) Varicellavaccinations, administered at least one month apart.

• All Varicella vaccinations must be documented on the Vaccination Cardincluding• Date of administration AND• Batch number if given within last 2 years AND• Health care provider signature AND• Health care provider practice stamp OR

• Positive Varicella IgG serology OR• Australian Immunisation Registry (AIR) History Statement that records

natural immunity to chickenpox• Documented on Vaccination Card with date of serology, health care

provider signature and health care provider practice stamp.TB

TB Screening- Interferon Gamma Release Assay (IGRA) or Tuberculin Skin Test (TST) is required if:

• If you were born in a country with a high incidence of TB, or have residedor travelled for a cumulative time of 3 months or longer in a country with ahigh incidence of TB, as listed at:http://www.health.nsw.gov.au/Infectious/tuberculosis/Documents/countries-incidence.pdf,

• OR if you have previously been assessed as TB compliant but have residedor travelled for a cumulative period of 3 months or more to acountry/countries with a high incidence of TB since your last TBassessment

• OR if you have had contact with a person who has infectious TB diseaseyou will require TB screening.

2021 NSW Vaccination Record Card Completion Guide 11 August 2021 Page 4 of 6

• IGRA blood test can be ordered by your GP - it must be done onemonth apart from the administration of any live vaccines (MMR &Varicella). IGRA results must be documented on your Vac Cardincluding:• Date of IGRA blood test AND either a positive or negative or

indeterminate result• Health care provider signature AND• Health care provider practice stamp• If your IGRA serology is indeterminate, a 2nd IGRA serology test will be

required with results recorded on the Vac Card• If your IGRA serology is positive you will require a Clinical Review at a

NSW Health TB Service/Chest Clinic where you will have a Chest X Rayand/or TST/Mantoux.

TST/Mantoux • Must only be performed at a designated NSW Health TB Service/Chest

Clinic, not by a GP or pathology company. It must be one month apart fromthe administration of any live vaccines (MMR & Varicella)

• If you have a history of a BCG vaccination or if you have never had a BCGvaccination, this must also be recorded on the Vac Card at ‘TB Screening’under “History of BCG vaccination’

TST/Mantoux Tests Interpretations:

• Reaction is negative, and no BCG scar, no further action• If reaction if positive, further advice required from a NSW Health TB

Service

All entries must include date, health care provider signature, health care provider practice stamp.

Influenza For all UTas students undertaking PEP during influenza season (1st June- 30th September each year), the annual influenza vaccination is mandatory. Evidence of the annual influenza vaccination MUST be provided prior to 1st June each year using the

• UTas Safety in Practice Annual Influenza Vaccination Formhttp://www.utas.edu.au/__data/assets/pdf_file/0013/1170103/Safety-in-Practice-Influenza-Vaccination-Form.pdf

OR another form of evidence, which can include Medicare Immunisation Statement, pharmacy/ hospital influenza consent form, GP immunization summary/list/statement or NSW Health Vaccination Record Card for Health Care Workers and Students.

IGRA

2021 NSW Vaccination Record Card Completion Guide 11 August 2021Page 5 of 5

Sample Vaccination Card

Vaccination Record Card for

Health Care Workers and Students

�tk NSW GOVERNMENT

Personal Details (please print) Please refer to instructions on page three

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Milky Way General Practice >---- --------=-------------�-, Southern Cross Drive Dose 1 ,.,., I A- �� \ '2-� 1--- - --- - ----'---..j1-1--Jl!""""'-'=L-::..J_+-'n----'---= '-=----•-----'-'--= .D,e___:_..::.......c=--:'-'---'==;,:.-1 Outer Galaxy NSW 2099Booster Provider No: 1234567 A 70 years after previous dose Booster 70 years after previous dose -

u�::-------------..,_______ _j 1--�- --�-- -�.�------------�, Dr Full Moon Hepatitis B vaccine (age appropriate course of vaccinations A/II

ositive Milky Way General Practicer=���-------.-.-+--------------r1 Southern Cross Drive 1--D_o_s _e _l _ _____ �..,....._---+----�����-, Outer Galaxy NSW 2099

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Southern Cross Drive 1-----------+-----+----- - ------+ 1 Outer Galaxy NSW 2099

Provider No: 1234567A 1--------- - -------,-----+- ---- - ------+I

Dr Full Moon AND f--c-----------=--------------, Milky Way General Practice

Serology anti-HBs ..., --n I Result IO�IU/mL Southern Cross Drive .......,...N�u=m�e�ric=a=l�v=a�lu=e�--+-+---+-�-vV_L-1-+----------- 1 Outer Galaxy NSW 2099

Result m!U/mL Provider No: 1234567A1----------------,1------+-----------1

OR Serology: ant i-HBc Positive Negative

Serology Measles lgG Result

Serology Mumps lgG Result Serology Rubella ( include numerica l va lue and immunity status as per la b repo rt: Posit ive/ Negative /Low level/ Eq u ivocal Booster re uired

lgG Result Varicella vaccine (age appropriate course of vaccination OR positive serology OR AIR history statement that records natural

Dose 2

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Aust ralian Immunisation Registe r (AIR) H isto ry Statement that records natural immun ity to ch ickenpox

Revised February 2021

AIR Statement Sighted YES NO

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Page 5 of 6

Surname Caku rt)r,r Given

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Vaccination Record Card forHealth Care Workers and Students

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Personal Details (please print)

lnfluenza vaccine (strongly recommended for all health care workecare workers)

health

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Dr Full MoonMilky WaY General Practice

Southern Cross DriveOuter GalaxY NSW 2099

Provider No: 1234567A bt4

Requires TB screening? iltlzor r.ro (veslHistory of BCG No Yes

IGRA il4,*, oositive lndetermrrateKIilI\

TST Administration

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Tuberculin Skin Test (TST) - TB Service/Chest CIinic

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(IGRA) - GP or TB Service/Chesl Dr Full MoonMilky Way General PracticeSouthern Cross DriveOuter Calaxy NSW 2099 JProvider No: 123.1567A

TST Reading nduration mm

TST Administration

TST Reading I nd u ratio n mmReferral to TB Service/Chest Clinic for TB ClinicalReview reouired?

No Yes

TB Clinical Review

Chest X-ray

Other

TB Compliance - TB Service/Chest CjjAic-oqQASV Assessor (circle ( KStfiT.IfiqqRIHB}

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TB ComplianceAssessment

CompliantTemporary ComplianceNon-compliant

TB Screening Date Batch No. or Result

Vaccine Date Official Certification by Vaccination ProviderBatch No. (where possible) orBrand name

Revised February 2O2l 2/z

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