Checklist 3 (Clinicals)

Due Date: End of Week 3

Step 1: Fill out the checklist

The forms do not download correctly from most phones. Students can access computers for free at the Valencia TLC Links to an external site. and Library Links to an external site. and the Canyon Country Library and Learning Center Links to an external site. in the Student Services Building. Students who have paid the Student Support Fee can print documents for free (worth up to $16/month ) through the Wepa app.

• Download and save Checklist 3 Download Checklist 3
• Open the saved file
• Type your information in the top part of the form - leave the EMT # blank for now
  • Your Last Name, First Name
  • Instructor's Last Name (for HLHSCI-151 on Tuesdays)
  • Use the dropdown to select the semester and year
  • EMT # - leave blank
  • Do NOT check the boxes 
  • Do NOT use staples

Step 2: Complete the Items on the Checklist

• Click "Next" at the bottom of the screen and follow the directions to complete each item

Step 3: Documentation

• When you have completed each item, add it to Checklist 3 in the order on the checklist
• Use a paperclip to attach the forms to the checklist - no staples!
• Do not check the boxes on the checklist - your instructor will do that when they review the packet
  • We need photocopies of your CPR and Fire Safety cards and your EMT Badge
  • We need your medical records showing actual lab results from the titers PLUS the physical forms
  • We need your medical records showing vaccination date, lot number, and dose received PLUS the physical forms
  • We need your medical records showing TB test results PLUS the physical forms 

• The quickest way to get all of this done is:

• • Quantiferon and titers drawn (same day)
  • Get booster shots when titer results come back
  • Get the physical and get copies of the titer results and your shot record