(C133) Child & Youth Care (Fall Term 2024)

3rd year: Returning Semester 5 & 6 students

Renewal Health Form deadline: July 31, 2024

RETURNING STUDENT CHECKLIST & ACTION REQUIRED

Notice: If you are planning to continue your studies in this program, it is your responsibility to start and meet all the health form
requirements outlined below. This process will take about 4-6 weeks to complete, and you must have a “clear” vulnerable sector check
valid every year. If you fail to complete and submit these requirements to ParaMed by the given deadline, you will be excluded from
clinical practice which can jeopardize your academic standing & lead to program withdrawal. All costs, service fees and fines associated
with the overall medical and additional requirements are the responsibility of the student.

MEDICAL REQUIREMENTS (Mandatory)

Book an appointment with your doctor/Walk-In Clinic. Bring this health form to your appointment and advise your doctor to sign and stamp
your health form documents upon completion of all medical requirements. Please read all detailed instructions on pgs. 2 & 3

 Step 1-Tuberculosis Skin Test (renew every year), pg. 2

 Temporary Medical Exception (page 2)
 Final signature of your doctor/physician and medical office stamp, pg. 2

ADDITIONAL REQUIREMENTS (Mandatory)

Please read all detailed instructions on pages

 Vulnerable Sector Check (renew every year) pg. 3
 ParaMed Placement Pass Service, pg. 3
 ParaMed and George Brown College Agreement Form pg. 4

PARAMED PLACEMENT PASS SERVICE FEES (rates are subject to change, student pays)

Once you have everything completed, your final step is to create an account, submit and upload your completed health form documents
to the ParaMed Placement Pass website at https://georgebrowncollege.placementpass.ca/ by the given deadline.

(June 1, 2022 to May 31, 2025)

• Initial Submission Fee - $59.47 dollars (submission of health form, RN fee, archives & medical access online)
• Resubmission Fee (due to a Deficiency List Form) - $26.10 dollars

CONTACT US
Suzette Martinuzzi, Preplacement Coordinator
Sally Horsfall Eaton School of Nursing, Clinical Placement Office
George Brown College
Tel#: (416) 415-5000 ext. 3415
Email: smartinu@georgebrown.ca or CPOHealthForm@georgebrown.ca
Business Hours:
Monday-Wednesday (9:00 am-4:00 pm): 51 Dockside Drive, Room 702, 7th Floor, Waterfront Campus,
Thursday-Friday (9:00 am-4:00 pm): 200 King Street East, Room 401B, 4th Floor, Main Building A, St. James campus,

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 (C133) CHILD & YOUTH CARE PROGRAM
3rd YEAR RETURNNING RENEWAL HEALTH FORM (FALL TERM 2024)

Name x___________________________________________
GBC ID# x________________________________________
Tel x____________________________________________
Email x__________________________________________
ParaMed submission deadline: July 31, 2024

MEDICAL REQUIREMENTS
(DOCTOR/PHYSICIAN/HEALTH CARE PROFESSIONALTO COMPLETE, SIGN & STAMP)
Ontario legislation specifies certain surveillance requirements for those individuals entering into healthcare practice settings. The Program policy was
developed in accordance with the Communicable Disease Surveillance protocols, as specified under the Ontario Public Health, OHA, OMA, LTCAO and
Ontario School Boards to demonstrate students’ meet these requirements prior to entering placement settings. This process is necessary to ensure that
our students protect their health and safety, and the health and safety of patients, children, seniors, employees and other vulnerable people. The completion
of this information is not optional, and all sections must be completed as outlined. Our placement agency partners have the right to refuse students who
have not met their immunization standards. If, for medical reasons, your patient is unable to receive a required immunization or Chest X-ray, a medical
note of this exclusion must be provided on the form.

1. STEP 1 TUBERCULOSIS SKIN TEST (renew every year, see instructions below)
• Negative (-) (less than < 10 mm induration) If your previous Two Consecutive Step-TB Skin Test results was both
“Negative with less than (< 10 mm)” induration from last year, please ask your doctor to renew your Step 1-TB Skin Test
only and document it below.

• Positive (+) (more than > 10 mm induration) If your previous TB Skin Test result was “Positive with (over > 10 mm
induration) from last year, you are NO longer required to do anymore TB Skin Test or Chest X-ray again. Please advise
your doctor to do annual TB physical examination and complete letters (A-F) below. No Exceptions!

CURRENT YEAR: STEP 1 TB SKIN TEST

________________/_____________________________________________/__________________________________
(Date Given: mm / dd / yyyy) (Date Read: 48-72 hours after date given) (Induration size) (mm)

TB SKIN TEST POSITIVE WITH MORE THAN >10 MM INDURATION

DOCTOR/PHYSICIAN MUST DO ANNUAL TB PHYSICAL EXAM & COMPLETE LETTERS (A-F) BELOW:

a) Chest X-ray (attach a copy of the Chest X-ray report valid within two years) Result_______ Date_________(mm/dd/yyyy)

b) History of disease? Yes or No Date (mm /dd/ yyyy) _______________________________________________

c) Prior history of BCG vaccination? Yes or No Date (mm /dd/ yyyy) _________________________

d) Does this student have signs/symptoms of active TB on physical examination? Yes or No

e) INH Prophylaxis (Treatment)? Yes or No Date (mm/dd/yyyy) __________________ Dosage_______________

f) Specialist (Public Health) Referred? Yes or No Date (mm/dd/yyyy) ________________________________

Final Signature of doctor/physician/health care professional___________________________________ (pg.2)

Date (mm/dd/yyyy) _____________________Medical Office Stamp__________________________________(pg. 2)

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 3rd YEAR (C133) CHILD & YOUTH CARE PROGRAM
RETURNNING RENEWAL HEALTH FORM (FALL TERM 2024)
TEMPORARY MEDICAL EXCEPTION TO YOUR PARAMED ACCOUNT
(Submission deadline on July 28, 2024)

NAME x__________________________________ GBC ID# x________________________________

2. Did you receive a Temporary Medical Exception from your last submission to your ParaMed Placement
Pass account? If so, go to Section A. If not, go to Section B.

➢ Section A)
Please sign-in to your ParaMed Placement Pass account and check for any COMMENTS that were posted by
the nurse to your portal account. Please show your doctor your old health form documents or the Student
Status Summary report, complete any of the outstanding booster or repeat blood test and have them fill-out
and complete this part of the Health Form.

Please note that your Temporary Exception will expire, if you fail to submit any medical updates ParaMed will
mark you as NOT CLEAR and you will be EXCLUDED from clinical or field or dental practice.

▪ Tetanus, Diphtheria & Pertussis (TDAP/Adacel valid every 10 years)

dose date: _____/_____/___(mm/dd/yyyy)

▪ Measles, Mumps & Rubella (MMR)

 outstanding dose date: _____/_____/____(mm/dd/yyyy)

OR
 outstanding copy of repeat laboratory blood test report

▪ Varicella (Chicken Pox)

 outstanding dose date: _____/_____/____(mm/dd/yyyy)

OR
 outstanding copy of repeat laboratory blood test report

▪ Hepatitis B

 outstanding booster shot dose date: _____/_____/____(mm/dd/yyyy)

OR
 outstanding copy of repeat laboratory blood test report, 4-6 weeks from your last
dose

➢ Section B) If you already received a ParaMed Clear Certificate from your previous health form document,
please disregard this page 3 and there is no need for your doctor to fill-out this form or redo any of the
medical requirements given above.

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 (C133) CHILD & YOUTH CARE PROGRAM
3rd YEAR RETURNNING RENEWAL HEALTH FORM (FALL TERM 2024)

ADDITIONAL REQUIREMENTS (submission deadline is on July 31, 2024)

NAME x_____________________________________________________ GBCID# x_____________________________________

3. VULNERABLE SECTOR CHECK (renew every year)

Note: Your academic department requires that all students must have a “clear” vulnerable sector check valid for the
academic year. Please attach the original police vulnerable sector check record and submit it to ParaMed. If you are excluded
from placement due to a "not clear" vulnerable sector check, it will jeopardize your academic standing and can lead to
withdrawal. Please contact your Chair to discuss this matter before you register and pay for this program. All costs associated
with the vulnerable sector check application and additional fees related to fingerprint, court documents and Record
Suspension (formerly Pardon) process are responsibility and paid by the student. Please read instructions below in how to
apply for your police check according to your regional police service below.

For students who reside in the Toronto region:

If you need to apply for your VSC and you currently reside in the Toronto region with a postal code that starts with the
letter M, follow these steps:
❖ Contact Suzette Martinuzzi, Clinical Pre-placement Co-ordinator to request the VSC Organization Code.
❖ Once you have the code, go to the Toronto Police Service website.
❖ Scroll down to Vulnerable Sector Check, and read the information provided. Then scroll down to the Register for an
Adult Police Record Check Account box and select the Fill Out Form button.
❖ Complete the “Registration Account Information” and select the “Process My Registration” button. This creates your
account. Now you must complete the six stages (Report, Documentation, Demographics, Payment Status,
Authentication Status, and Application Status) of the VSC application. All six stages are mandatory.
❖ On the Report Selection page, scroll down to the Vulnerable Sector Check table and choose the Unpaid Student
Placement option. Then go to the Reason for the Police Record Check table and complete as follows:
❖ under Course Name, type your course (or program) name
❖ under VSC Organization Code, type in the code provided to you by the Clinical Pre-placement Co-ordinator
❖ under Vulnerable Clientele Duties, type "To provide care, support, and guidance for the health and well-being of
vulnerable persons from 1 to 99 years old"
❖ where you have to list which vulnerable sectors you will be working with, type "Children, teenagers, elderly, seniors,
and persons with physical and mental disability"
❖ Finish answering the remaining stages. Note that payment for your online application must be provided by credit card
only.
❖ Once your submission has been finalized, Toronto Police Service will send you an email notification indicating when
you will receive your VSC results to your email account. Processing times typically take 4 weeks from the date the
application is received but may take longer due to volume of requests and/or time of year.

For students who currently reside in another region such as (Durham, Halton, Hamilton, London, Niagara, Peel &
York) or Out of Province. (If your Postal Code starts with the letter “K, L, N, P”, or other province).
• Please check your specific regional police service website and they can take two-six weeks to process your application
form, with exception to Niagara region which takes 10 weeks to process.
• If you require a volunteer letter, to pay for the student rate (except Peel region), please email us your full name, GBC
ID#, program name and your regional police service complete address. For more details, visit Vulnerable Sector Check
website.

Vulnerable Sector Check

 Issued Date _____/_____/________ Expiry Date_____/_____/_______ (one year after the issued date)
mm/ dd / yyyy mm/ dd / yyyy

FINAL STEP: Once you have everything completed, your final step is to create an account, submit and upload your
Health Form documents to the ParaMed Placement Pass website at https://georgebrowncollege.placementpass.ca/
by the given deadline. After this step, it is mandatory that you keep all your original health form documents and
certificates, as you need to show this proof of records to your upcoming placement agency and for future reference.

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 George Brown College & ParaMed Agreement Form

Name x___________________________________________________________

Program: (C133) Child & Youth Care -3 r d year Returning in Fall Term 2024

I x__________________________________________ (Print Name) understand that any false statement is grounds for
cancellation of admission.

I understand that the college has the right to cancel my admission privilege on the basis of medical information submitted or
withheld. I understand that it is my responsibility to inform the appropriate George Brown College personnel of any
communicable disease, special need, exception or medical condition which may place me at risk or pose a risk to others at
George Brown College or on placement.

I will pay all the services fees and authorize ParaMed to review the above information.
x__________________________________________________________________
(Signature) (Date)

Element of Risk

All experiential learning programs, such as field trips, clinical and field placements or job shadowing involve certain
elements of risk. Injuries may occur while participating in this activity without any fault of the student, the placement
or the college. By taking part in this activity, you are accepting the risk that you may be injured. Following the Health
and Safety rules of your placement is required. By signing below you agree that you have reviewed the element of
risk and are willing to comply with the Health and Safety Rules of your placement.

If an injury should occur, it must be reported immediately to your supervisor and to your faculty. Completing Workers
Safety Insurance Board forms and reporting any injury while participating in placement must take place within 72
hours of occurrence.

x________________________________________________________________________________________
(Signature) (Date)

Contact Us
Suzette Martinuzzi, Coordinator via email smartinu@georgebrown.ca
Virtual Hours: :900 am to 3:00 pm, visit FT Program Pre-placement

FREEDOM OF INFORMATION ANDPROTECTION OF INDIVIDUAL PRIVACY ACT

The personal information on this form is collected under the legal authority of the Colleges and Universities Act, R.S.O. 1980, Chapter
272, Section 5, R.R.O. 1990, Regulation77 and the Public Hospital Act R.S.O.1980 Chapter 410, R.S.O. 1986, Regulations65 to 71 and
in accordance with the requirements of the legal Agreement between the College and the agencies which provide clinical experience for
students. The information is used to ensure the safety and wellbeing of students and clients in their care.

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