General Safety Training Quiz - LVHN
Please print this entire file.
Complete all of the information and return it to LVHN Office of Student Affairs in one stapled packet.
If required orientation documentation is not submitted and arrangements with the unit Director, PCC, or PCS have not been made at least two weeks prior, the clinical start date will be delayed until all requirements are complete.
If the Faculty member is a current LVHN employee, in lieu of duplicating orientation documentation requirements, please complete an Employee Orientation Exemption Form. Employed faculty are still responsible for contacting the unit Director, PCC or PCS 2 weeks prior to the clinical start date to discuss course objectives, unit requirements, unit initiatives, unit orientation etc.
Orientation Requirement Parameters
➢ Documentation of Orientation packets must be completed annually
➢ NEW instructors to LVHN must complete all criminal and health clearances prior to starting.
If your school has your health and criminal clearances on file, please have them complete the School Documentation Form in lieu of submitting the health and criminal clearance forms.
➢ Instructors are responsible for contacting the unit Director, PCC or PCS 2 weeks prior to each clinical session to discuss course objectives, unit requirements, unit initiatives, unit orientation etc.
Please send all documentation in one packet to:
Office of Student Affairs
1247 South Cedar Crest Blvd.
Suite 202
Allentown, PA 18103
Attn: Maggie Hadinger
Fax: 610-402-2203
Direct all questions to:
Margaret_A.Hadinger@ 610-402-2475
LEHIGH VALLEY HEALTH NETWORK
FACULTY ORIENTATION DOCUMENTATION
Name: ______________________________________________________________________________
Social Security Number: ________________________ DOB: __________________________________
(This information is REQUIRED and is used in our Security systems to create your computer access)
Current Address _______________________________________________________________________
Email ________________________________________________________________________________
Home Phone __________________________________ Cell Phone ______________________________
Emergency Contact Name _______________________________________________________________
Emergency Contact Relationship __________________________________________________________
Emergency Contact Phone _______________________________________________________________
School/Affiliation: _____________________________________________________________________
Please check all that apply:
• Healthcare Provider BLS (CPR) is current. Copy attached.
• All health requirements are met and documentation attached.
• Criminal Clearances information is completed and attached.
• If RN, copy of current license is attached.
• If RN, evidence of professional liability insurance is attached.
I have received education related to the following:
➢ Identification Badge Parking Assignment
➢ PRIDE Initiative LVHN – Hospital Plan for Provision of Patient Care
➢ Code of Conduct Patients Rights and Responsibilities
➢ Confidentiality Pastoral Care
➢ Rapid Response Team Code Blue
➢ Emergency Codes No Smoking Policy
➢ Administrative Dress Code and Dress Code Policy for Patient Care Services Requirements for Hand Hygiene for Hospital Personnel
➢ Patient Identification Domestic and Intimate Partner Violence
➢ Restraint and Seclusion Policies and Procedures/Restraint Alternatives Patient Safety Report
➢ Employee Incident Report (Use for Student/Faculty Injury) Visitor Injury Reporting
➢ HIPAA
➢ Safety/Environment of Care
➢ General Safety
Security Management
Chemical Hazard Communication
Waste Management
Emergency Management
Fire Safety
Accident Prevention Signs & Tags
Lockout/Tagout
Compressed Gases
Latex Allergy
Bloodborne Pathogens – Blood/Body Fluid Exposure
Tuberculosis and Respiratory Protection
➢ Patient Safety Part 1: Patient Safety Reporting: Pennsylvania MCARE/Act 13
➢ Patient Safety Part 2: JCAHO’s National Patient Safety Goals
➢ Fall Prevention LVHN Corporate Compliance
➢ Bridging Cultures: Delivering Culturally Appropriate Care Interpreters
➢ Stroke Alert DVT
➢ Behavioral Health Overview (Applicable for Psychiatric Experience)
__________________________________________________
Signature
Please check ALL that apply:
( Are you 40-70 years old?
( Veteran (other than Vietnam-era)
( Vietnam-era Veteran (served on active duty between 08/05/64 and 05/07/75)
( Disabled Veteran (Vietnam-era only)
( Disabled Veteran (other than Vietnam-era)
( Handicapped (person who 1} has a physical or mental impairment which substantially limits one or more of such person’s major life activities; 2} has a record of such impairment; or 3} is regarded as having such an impairment)
Ethnicity (please check ALL that apply)
( White (not Hispanic or Latino origin). A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
( Black or African-American (not Hispanic or Latino origin). A person having origins in any of the black racial groups of Africa.
( Asian or Pacific Islanders (not Hispanic or Latino origin). A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
( Native Hawaiian or Pacific Islander (not Hispanic or Latino origin). A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
( American Indian or Alaskan Native (not Hispanic or Latino origin). A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
( Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
( Other
Gender
( Male
( Female
US Citizen
( Yes
( No
Residency (please check only one)
( I am a resident of Pennsylvania and have been for at least two years.
( I am a resident of Pennsylvania but have not been for at least two years.
( I am not a Pennsylvania state resident.
Have you ever been convicted of a misdemeanor or felony since your 16th birthday?
( Yes
( No
If yes, please explain ___________________________________________________________________________
GENERAL SAFETY TRAINING QUIZ
True or False
SAFETY
1. Prevention is the key to a safe and healthy workplace.
2. It is not necessary to fill out an incident report form if you told your supervisor about your work related injury.
SECURITY MANAGEMENT
3. Aggressive behavior, visitor falls, theft, vandalism are examples of emergency situations that should be reported to Security by dialing 555.
4. High-risk areas throughout LVHHN include the Emergency Department, Psychiatric units, Pharmacy and Pediatrics.
HAZARDOUS MATERIALS AND WASTE MANAGEMENT
5. Material Safety Data Sheets (MSDS) are available for all hazardous chemical products used at LVHHN and contain important information detailing how to handle the product in a safe manner.
6. Hazardous waste and infectious waste are the same waste stream.
7. Chemical products must be labeled by the manufacturer with appropriate hazard warnings.
8. It is not important to review a products MSDS sheet before working with that product.
9. Red bag waste costs approximately five times more to dispose of than regular waste.
10. We recycle cardboard, paper, aluminum, glass, and plastic at LVHHN.
LIFE (FIRE) SAFETY
11. Your first responsibility when you discover a fire is to rescue everyone in immediate danger.
12. Clean, uncluttered corridors are an important part of a successful Fire Safety program.
13. Fire extinguishers should be aimed at the top of the fire.
Fire Response -- Place in the correct order from 1 - being first to 4 - being last.
Contain/close doors Evacuate/extinguish small fires
Activate alarm ____ Rescue everyone in immediate danger.
EMERGENCY PREPAREDNESS
15. Dial 555 to report all Emergencies.
16. Emergency preparedness response only involves external emergencies.
EQUIPMENT MANAGEMENT
17. Critical Equipment should be plugged into red outlets because they are the only outlets that function during a power failure.
UTILITIES MANAGEMENT
18. The process of de-energizing and securing equipment is referred to as Lockout/ Tagout.
19. Matching - If you experience a utility failure, match the system with the department that you would notify:
1. Water/Electrical outage A. Respiratory Therapy
2. Computer B. Telecommunications
3. Telephone C. Information Services
4. O2 Supply D. Engineering
BLOODBORNE PATHOGENS
20. If you sustain an exposure to blood or body fluid and need additional information, you can call 402 - STIK.
21. Standard Precautions means that all blood and body fluids are considered potentially infected with a bloodborne pathogen.
22. The type of PPE you use depends upon the task you are performing.
23. You can wait until the end of your shift to clean the area that became contaminated with blood or body fluid.
24. The Exposure Control Plan is located in the Infection Control Manual.
TUBERCULOSIS
25. ___ Tuberculosis infection may be acquired when a person breathes in the tubercle bacillus from the air surrounding a person with active tuberculosis.
26. ___ You can wear an N-95 respirator without fit-testing and medical clearance.
27. ___ The Tuberculin Skin Test indicates whether you have been infected with tuberculosis.
Signature: __________________________________________________
Date Completed: _____________________________________________
HIPAA EXAM
TRUE OR FALSE:
1. _____ You see a stranger pick up a patient’s chart. You should stop him and ask for
his identification.
2. _____ Nancy needs a new password. She uses her mother’s birthday and her father’s
initials. The new password is 0323js34. This is a good password.
3. _____ Jeff can’t get into Lastword (Phamis). It’s okay for Donna to let him use her user ID
and password during his shift.
4. _____ When sending a fax containing PHI, Kim should verify the correct fax number and
include a cover sheet.
5. _____ Lisa receives an e-mail titled “LUV U 4 EVER” from Steve, a co-worker. Since she
knows who sent the message, it is safe to open it.
6. _____ Jan is viewing a patient’s lab results on a computer workstation in the hospital. It’s
okay for her to allow the patient’s daughter to view the results over her shoulder,
because she is a nurse and works on the same unit as Jan.
7. _____ It’s okay to write your password down as long as the paper is kept out of the reach
of others.
8. _____ It is okay to include Protected Health Information (PHI) in an external e-mail, as long as
the recipient’s address has been double-checked prior to mailing.
9. _____ A patient’s immediate family should always be given access to the patient’s medical
records upon request.
10. _____ Screen savers help keep Protected Health Information out of view.
11. _____ While riding a crowded elevator, Susan tells Ellen she must not enter Mr. Brown’s room
in TTU because he is under isolation precautions. This was an appropriate location to
share this information because they were not near the patient’s family.
12. _____ Unauthorized access to computer-based information can occur if a user does not
sign off of the computer.
MULTIPLE CHOICE:
13. _____ What is HIPAA?
a. Heparin Induced Platelet Aggregation
b. Health Insurance Portability and Accountability Act
c. Hospital Induced Pneumococcal Pneumonia
d. Hospital Insured Poly-Pharmacy Administration Act
14. _____ Protected Health Information (PHI) consists of:
a. Written or printed documents
b. Computerized information
c. The spoken word
d. All of these
15. _____ What are the four categories of information at Lehigh Valley Hospital and Health
Network?
a. Public, Private, Confidential and Restricted
b. Unclassified, Private, Confidential and Restricted
c. Public, Internal Use, Confidential and Restricted
d. Unclassified, Internal Use Only, Confidential and Restricted
16. _____ Before releasing Protected Health Information (PHI) to anyone outside of the patient’s
care providers, you should contact:
a. The Nursing Unit Director
b. Physician Relations
c. HIM (Medical Records)
d. All of these
17. _____ Viruses can enter the computer system in which of the following ways:
a. Floppy disks
b. Internet
c. E-mail
d. All of these three ways
18. _____ Which of the following is the first line of security for computer systems at
Lehigh Valley Hospital and Health Network?
a. Passwords
b. Screen Savers
c. Locking Workstations
d. All of these
19. _____ Which of the following is a good password?
a. scooby8
b. 122333
c. drowssap
d. 815ts90
LEHIGH VALLEY HEALTH NETWORK
ACKNOWLEDGEMENT OF CONFIDENTIALITY
I understand that as a employee of Lehigh Valley Hospital (along with its components and subsidiaries), member of the medical staff, physician office employee or non-hospital patient care provider or support personnel (volunteer, intern, student, contractor, vendor, etc.), the performance of my job/duties may require me to access or become aware of the following confidential information:
-- Patient health care and financial information
-- Employee personnel, compensation and health care information
-- Physician performance and personnel information
-- Business information relating to Lehigh Valley Health Network
I understand that access to and use of this information in verbal, written or electronic (stored in a computer) form is a privilege. I also understand that access to information is granted to me based on business or clinical “need to know” standards and the responsibilities of my job as an employee or non-hospital patient care provider or support personnel.
I understand that I may not seek information that is not required to do my job. I also understand that I may share information only when necessary to do my job. I agree to store and dispose of information which I use in a way that ensures continued security and confidentiality.
I understand that the methods I use to get information may only be used in the performance of my job. If I require special authorization to access computer-based information, I understand that my computer sign-on information may only be used by me.
I also understand that I may not give my sign-on information to anyone, and that this information is the same as my written signature. I accept full responsibility for any use of my sign-on information.
I understand that Lehigh Valley Health Network has a Corporate Compliance Program and that I have been provided education regarding the program. I also understand that I have a role in preserving Lehigh Valley Health Network’s corporate integrity and thus have an obligation to report potential compliance issues. I was informed of the Compliance Hotline number, 1-877-895-2905.
I declare that I have read and understand this acknowledgment. I have had an opportunity to ask questions and have them answered. I recognize that giving confidential information at any time during or after my employment or affiliation with Lehigh Valley Health Network may cause irreparable damage to Lehigh Valley Health Network, the patient or the health care provider. Accordingly, Lehigh Valley Health Network or the owner of such information may seek legal remedies against me, such as fine, criminal penalties, suspension or termination of employment.
Any employee who has concerns about the safety or quality of care provided in the hospital may report those concerns to the Joint Commission on Accreditation of Health Care Organizations: E-mail: complaint@ Fax: 630-792-5636 Mail: Office of Quality Monitoring, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Boulevard, Oakbrook Terrace, IL 60181. No disciplinary action will be taken if an employee makes a report to JCAHO.
_________________________ ___________________________ ________________
Name Signature Date
I presented the material to the above signed person as per the guidelines in the Confidentiality Policy. I have given the above signed person the opportunity to ask, and have answered all questions.
____________________________________________________________ _________________
Signature/Title Date
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