General Safety Training Quiz



Please print this entire file.

Complete all of the information and return it to your instructor or LVHN Office of Student Affairs in one stapled packet with the “REQUIREMENTS CHECKLIST” form on top.

In order for a student to be approved to begin, the orientation materials must be completed and received by the Office of Student Affairs at least two weeks PRIOR to any experience at LVHN. Criminal clearances must be received prior to the start of the student’s educational experience at LVHN.

LVHN OSA will email student and preceptor once the student’s paperwork is approved.

If required orientation documentation is not submitted at least two weeks prior, the student start date will be delayed until all required documentation is complete.  

If the student is a current LVHN employee, in lieu of duplicating these requirements, please complete an Employee Orientation Exemption Form, as posted on newstudent.     

If the health and criminal clearance requirements have been met through an affiliation agreement with the student's school, the school should submit documentation that the requirements have been met. Check newstudent for School Documentation Form. In this case, each individual student need only submit this Documentation of Education. 

Please mail, fax, or deliver all documentation in one packet to:

Office of Student Affairs

1247 South Cedar Crest Blvd.

Suite 202

Allentown, PA 18103

Fx: 610-402-2203

Direct all questions to:

Research Scholars:

Jean.Hoffman@ - 610-402-2569 

BTG CHIP Interns :

Monet.Thorne@ – 610-402-2482

All Other Students

Monet.Thorne@ – 610-402-2482

Additional Points to Consider:

← If you will need computer access, please ask your preceptor/mentor/supervisor to request for you directly by submitting a WISAR request online. Call Information Services at 610-402-8303 with questions.

← All students completing a clinical rotation or internship must wear appropriate identification including: color photo, title/role, and full name.All students must submit a copy of their school identification badge with their completed paperwork for approval.  Once your experience has been approved you must wear your school identification badge at all times during your clinical experience at LVHN.

LEHIGH VALLEY HEALTH NETWORK

ORIENTATION REQUIREMENTS CHECK LIST

|( |Requirement: |Submit to: |

| |Complete Health Certificate |LVHN OSA |

| |Complete Quantiferon or 2 step TB testing |LVHN OSA |

| |9 panel urine drug screen (pharmacy students only) |LVHN OSA |

| |Complete CPSL affidavit |LVHN OSA |

| |Complete PATCH request. |PATCH |

| |Copy of complete PATCH request. |LVHN OSA |

| |When received, completed PATCH report. |LVHN OSA |

| |Complete CAHC application, consent, and money order. |Submit to address on form. |

| |Copies of CAHC application, consent, and money order (completed report will be sent to LVHN OSA). |LVHN OSA |

| |Complete fingerprinting for FBI Clearance consistent with the Child Protective Services Law (CPSL). |COGENT |

| |Submit copy of COGENT form. |LVHN OSA |

| |When FBI CPSL results are received, send copy. |LVHN OSA |

| |Submit copy of RN license and professional liability insurance (graduate nursing students only) |LVHN OSA |

| |Send photocopy of school issued ID badge |LVHN OSA |

| |Be sure to review LVHN “Orientation Documents” as posted on newstudent. Your preceptor will | |

| |provide more specific orientation to the particular department/unit where you will complete your | |

| |experience. | |

LVHN OSA Comments:

LEHIGH VALLEY HEALTH NETWORK

DOCUMENTATION OF EDUCATION

Name of Student: _____________________________________________________________________

Social Security Number: ________________________ DOB: __________________________________

(This information is REQUIRED and is used in our Security systems to create your ID badge and computer access)

Student Current Address _________________________________________________________________

Email ________________________________________________________________________________

Home Phone __________________________________ Cell Phone ______________________________

Emergency Contact Name _______________________________________________________________

Emergency Contact Relationship __________________________________________________________

Emergency Contact Phone _______________________________________________________________

School/Affiliation: _____________________________________________________________________

Start Date of Experience at LVHN: _________________ End Date: ______________________________

School Graduation Date: ________________________________________________________________

Course/Program Name: __________________________________________________________________

Area of Assignment(s): __________________________________________________________________

Or Preceptor’s Name: ____________________________________________________________

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)

__________________________________________________

Student’s 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

School requirement (please check ALL that apply):

( This internship is required by my school.

( This internship is required by my program/major.

( I will receive credit for this internship.

Student will be participating in the Transitional Skills Unit (TSU) or in departments working in TSU (see list on newstudent):

( 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.

* For LVHN purposes, students who reside in Pennsylvania during the time of their participation in educational programming are considered residents of Pennsylvania.

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: _____________________________________________

June 2004, Reviewed August 2005, August 2006, November 2008, August 2011

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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