Listed below are the various forms required for clinical placements. All forms are in PDF format unless otherwise indicated. To save the form, right click on the link and choose "Save As" or "Save Link As."
Medical Requirements Guide – a list of required documentation for nursing students:
Hep B & PPD Form
– use this form if you only need HEP B and/or PPD
Nursing Student Badge Order Form
– information about how to order a nursing badge online
Flu Vaccination Form
– document proof of seasonal flu vaccination, proof of administration is required
Certified American Heart Association Health Care Provider Course Instructors
The following recommended* contacts are approved for instructing the American Heart Association BLS for Healthcare Provider (CPR and AED) Program.
Dereck Johnston (Cobb County ONLY)
*This is not a mandatory list
CPR cards obtained at the Owls Nest or through the Center of Health
Promotion and Wellness do not meet the requirements for Nursing Students
Front and Back copy of your CPR card is due by documentation deadline for submission to Immunitrax
Required Self-Study Modules (Bloodborne)
Must submit three certificates for credit:
- VIDM273A-T Preventing Bloodborne Infections: Bloodborne Viruses (w/Video) (0.5 hr)
- VIDM273C-T Preventing Bloodborne Infections: Engineering Controls and Workplace Practice Controls (w/Video) (0.5 hr)
- VIDM273B-T Preventing Bloodborne Infections: Preventing Transmission, Protecting Yourself (w/Video) (0.5 hr)
User ID: 9-digit student ID#, including zeros (example: 000112345)
After logging in with the above, click on the "Kennesaw" link, and then choose the module from above that you want to view. From the resultant window that opens, choose the "RealOne" Media Player option (the Windows Media is currently nonfunctional).
After completion of the course, print the certificates and submit them to Jeannette Clarke by email ( email@example.com) or by fax 470-578-9069, or bring them to her in Room 3004, Prillaman Hall.
For problems about logging in to self-study modules:
Contact Lisa Longeiret ( firstname.lastname@example.org)