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Faculty Forms

 

 

 

Nursing Department -> Faculty Forms
         
Faculty Forms - (For Faculty use only)

Final Clinical Student Evaluation Forms:

Clinical Simulation Forms:

Other Forms:

Basic HIPAA Training Read “HIPPA Privacy Basics & Intermediate Module
including Information Security Awareness” (17 pages) Print “HIPPA Privacy Post test”
and answer the questions. Fill in the date, your name, title (student) and submit to
the Nursing Program Office.

Workers' Compensation Forms-To be completed by the student and instructor and returned to the Nursing Program Office immediately.  Instructors are required to contact the course lead instructor or the Nursing Program office at the time the accident/injury/illness occurs. 

Although only the first 3 forms should be completed for the school, all forms should be reviewed by the injured party.

District Injury/Illness report
Employee Claim form, California DWC
Employer's Report of Occupational Injury, form 5020
Guidelines, California DWC
Instructions for Filing a Claim
Map to ALL other Sharp Occupational Medicine Facilities
Map to Sharp Rees Stealy in La Mesa
MPN Pamphlet
Predesignation Form (DWC Form 9783)

Worker Comp Benefits

 

 

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