PSW INFORMATION CHECKLIST - CDSBEO

PSW INFORMATION CHECKLIST

STUDENT NAME:

**IMPORTANT**

Please have photocopies of the items listed below ready to hand in at the orientation session. Please do not submit originals.

1 copy of multiple items will be retained in your student file and all other copies are intended for your clinical and work

placement file.

The Orientation Session is offered at five locations:

Location

Brockville

Cornwall & Morrisburg

Gananoque

Kemptville

Vankleek Hill

Date and Time

Friday, December, 4, 2015

3:00-5:00 p.m.

Wednesday, December 16, 2015

2:00-4:00 p.m.

Wednesday, December 2, 2015

3:00-5:00 p.m.

Friday, December 11, 2015

2:00-4:00 p.m.

Monday, December 14, 2015

1:00-3:00 p.m.

Location Details

St. Mary Catholic High School

40 Central Avenue, Brockville, ON

Cornwall Board Office (South Side ¨C Door B)

835 Campbell Street, Cornwall, ON

St. Joseph Catholic School

235 Georgiana Street, Gananoque, ON

St. Michael Catholic High School

2755 Hwy #43, Kemptville, ON

St. Jude Catholic School

5355 Highway 34, Vankleek Hill, ON

REC¡¯D

Provide 4 photocopies of a CURRENT VULNERABLE SECTOR SCREENING CHECK.

THIS SCREENING MUST INDICATE NO CONVICTIONS (NEGATIVE) IN ORDER TO BE ADMITTED TO PROGRAM.

Please contact your local Police Detachment for the fees and times of service.

Provide 4 photocopies of your IMMUNIZATION RECORD.

Needs to be completed to show proof of immunity for some placements.

Please note that blood titres must accompany the immunization record.

Provide 4 photocopies of the MEDICAL FORM COMPLETED & SIGNED BY YOUR DOCTOR.

Provide 4 photocopies of PROOF OF CURRENT TWO STEP TB TEST.

If step one-skin test-is positive, you must include a chest x-ray showing report of ¡°no active TB¡±.

See your doctor or call your health unit ASAP.

Provide 4 photocopies of INFLUENZA VACCINE.

Influenza vaccine is mandatory for clinical and co-op placements.

Provide 1 photocopy of your CANADIAN BIRTH CERTIFICATE.

Please note that if you are a non-Canadian citizen, you will need to provide proof of ¡°Citizenship & Immigration Canada

Documentation¡± at the orientation session. A form ¡°Confirmation of Residency and Eligibility¡± will be completed and

signed confirming that the data on the form is accurate. It will be examined to verify eligibility by a school board official.

Provide 1 photocopy of your PROOF OF RESIDENCY.

This may include an Ontario driver's license, tax bill, or lease agreement.

Provide 1 photocopy of your SECONDARY SCHOOL TRANSCRIPT.

Note: If you have an IEP, please provide us with it, so we can support you accordingly.

Provide 2 photocopies of A CURRENT RESUME OR A LIST OF JOBS YOU HELD ALONG WITH THE DATES EMPLOYED.

PAYMENT:

. THE MATERIAL FEE OF $1100.00 IS DUE IN FULL PRIOR TO THE START OF THE PROGRAM.

. IF YOU ARE SPONSORED BY AN ORGANIZATION - NOTIFICATION IS NEEDED FROM THE ORGANIZATION THAT THE FULL AMOUNT OF $1100.00

WILL BE PAID. PLEASE INCLUDE THE NAME OF CONTACT, TELEPHONE #, ETC.

PLEASE "¡Ì" THE NAME OF THE SPONSORING ORGANIZATION:

___

___

___

ONTARIO WORKS

ONTARIO MINISTRY OF TRAINING

ONTARIO DISABILITY SUPPORT PROGRAM

___

___

___

EMPLOYMENT INSURANCE

SECOND CAREER STRATEGY

JOB ZONE

NAME OF CONTACT PERSON/REPRESENTATIVE: ________________________________________

TEL. #: 613-_____________________ EXT. ___________

FAX #: 613-_______________________

Revised: October 28, 2015

?2014, Queen¡¯s Printer for Ontario

Page 1 of 12

PERSONAL SUPPORT WORKER

IMMUNIZATION & MEDICAL FORM

PERSONAL INFORMATION:

Student Name: ________________________________________________ Date of Birth: _____/____/_____

mm dd yyyy

Address: _________________________________________________________________________________

City: _______________________________________________________ Postal Code: __________________

Telephone #: _______________________________________________ Start Date: ____________________

_________________________________________________________________________________________

TO THE PHYSICIAN:

The above named individual is planning to participate in the Personal Support Worker Program.

The practical nature of this training program may require the individual to:

Provide support and companionship to vulnerable clients of varying ages. Duties involved may include aspects of

lifting, walking, standing, kneeling, bending, twisting requiring a full range of motion.

PLEASE VERIFY THE FOLLOWING:

1.

2.

3.

4.

5.

6.

Date:

Given by:

Signature:

Two Step TB (Mantoux) Test

Negative ¡õ Positive ¡õ

If # 1 positive, Chest X-ray

Negative ¡õ Positive ¡õ

Immunization against: (please note: blood titres must accompany the immunization record)

DPT

MMR

Varicella

Hep B

Flu Shot

General physical examination of the above named individual suggests that he/she is physically and

mentally fit to perform above duties.

¡õ Yes

¡õ No

Other/Comments:

Physician Signature: _________________________________ Dated: ____________________________

Name and Address of Physician: __________________________________________________________

_____________________________________________________________________________________

Revised: October 28, 2015

?2014, Queen¡¯s Printer for Ontario

Page 2 of 12

November 2015

To Whom It May Concern:

This letter is to confirm that ____________________________________________ has expressed interest in

registering for the January 2016 Personal Support Worker Program with the Catholic District School Board of Eastern

Ontario. The Brockville; Gananoque and Kemptville classes are scheduled to start on Monday, January 4, 2016; the

Cornwall and Morrisburg classes are scheduled to start on Monday, January 11, 2016 and the Vankleek Hill class is

scheduled to start on Monday, January 18, 2016. Placement and course ends in late June 2016. Please note: Each

course will run based on sufficient enrollment.

Conditional acceptance in the program depends on the student providing a current and negative Vulnerable Sector

Screening Check and proof of current TB test, which she/he already has (please see PSW Information Checklist). In

order for us to hold a position for her/him, we will require notification from your agency that the student will be

sponsored for the full amount of the course ($1100.00) by the date indicated below (by student¡¯s choice of location).

Location

Brockville

Cornwall &

Morrisburg

Gananoque

Kemptville

Vankleek Hill

Date and Time

Friday, December, 4, 2015

3:00-5:00 p.m.

Wednesday, December 16, 2015

2:00-4:00 p.m.

Wednesday, December 2, 2015

3:00-5:00 p.m.

Friday, December 11, 2015

2:00-4:00 p.m.

Monday, December 14, 2015

1:00-3:00 p.m.

Location Details

St. Mary Catholic High School

40 Central Avenue, Brockville, ON

Cornwall Board Office (South Side ¨C Door B)

835 Campbell Street, Cornwall, ON

St. Joseph Catholic School

235 Georgiana Street, Gananoque, ON

St. Michael Catholic High School

2755 Hwy #43, Kemptville, ON

St. Jude Catholic School

5355 Highway 34, Vankleek Hill, ON

Please find attached a copy of the program outline for your perusal.

I trust that the information provided is sufficient. Should you have any other questions, or require additional

information, please feel free to contact me at your earliest convenience.

Regards,

Kevin Dionne

Coordinator of Continuing Education and Experiential Learning

1-800-443-4562 ext. 293

Please note: No classes on Family Day; Good Friday and Easter Monday.

Revised: October 28, 2015

?2014, Queen¡¯s Printer for Ontario

Page 3 of 12

To whom it may concern:

The Catholic District School Board of Eastern Ontario¡¯s Personal Support Worker Program (PSW) begins in

January 2016 and ends in late June 2016. The PSW is a full-time (36 hours per week) program. Lastly, if

hired by the facility, a student may be paid for their co-op placement.

Fees associated with the program are as follows:

Item

Text Book/workbook (Mosby¡¯s Canadian)

First Aid/CPR

GPA Training

WHMIS

St. Peter Feeding Training

Mobility Training

Safe Food Handling Course

OLTCA Pin (registry list if they pass the course) ¨C presented at their graduation

Lab supplies per student

Component of facility rental

Equipment/Supplies Purchase, Replacement, and Repair

Restorative Therapy Training

Total Cost

Cost

$135.00

$135.00

$ 25.00

$ 30.00

$ 15.00

$ 70.00

$35.00

$ 16.00

$ 85.00

$262.00

$242.00

$ 50.00

$1100.00

Additional costs the student needs to pay prior to entering the program or during the program include:

Item

Scrub Uniforms (three required)

Non-slip white shoes

Misc Supplies

Doctor¡¯s Note

Hep B Immunization (three required)

TB (Mantoux) test

Current Vulnerable Sector Screening Check

Transcript

Transportation

Parking fees

Revised: October 28, 2015

?2014, Queen¡¯s Printer for Ontario

Approximate Cost

$40 each

$75.00-$100.00

$50.00-$75.00

$0-$150.00

$25.00-$75.00 each

$0-$25.00

$0-$50.00

$0-$20.00

Varies

Varies

Page 4 of 12

PERSONAL SUPPORT WORKER PROGRAM (PSW)

Program Outline

This intensive training program is intended to provide individuals with the theoretical, clinical and practical knowledge

and skill sets needed to perform personal support tasks, as a collaborative member of a client¡¯s health care/ support

team. Whether applying these skills in the community and/or facility based setting, our program philosophy

incorporates the principles of promoting client independence, dignity, safety and the delivery of compassionate care.

The PSW Program is accredited through O.C.S.A. (Ontario Community Support Association) and sponsored by the

Ministry of Education. This program follows the training standards set out by the MTCU (Ministry Training Colleges

and Universities) and graduates must demonstrate competency in fourteen (14) vocational learning outcomes, (VLO)

and essential employability skills (ESS) learning outcomes, divided between 7 program courses.

Program Duration:

6 hours for the Orientation and Registration session, 330 hours of in-class instruction, 90 hours of supervised clinical

workplace experience, 270 hours of coop workplace experience, and 7 senior secondary school credits towards the

Ontario Secondary Diploma requirements.

Program Courses:

Health Care, Grade 11, College (TPJ3C ¨C 110 hours/1 credit)

This course includes but is not limited to the training elements to have the student reliably demonstrate the ability to

work within the personal support worker role in community, retirement homes, long-term care homes and/or

hospital care settings; act responsibly and be accountable for one¡¯s own actions while recognizing the boundaries of

knowledge and skills within the personal support worker role and participate as a member of the inter-professional

care/service team.

PSW modules included in this course:

?

?

?

Orientation/Study Skills - 6hrs

Roles and Responsibilities

Interpersonal Skills

?

?

?

Overview of the Canadian Health

Care System

Infection Control

Mobility

?

?

?

Individuality

Introduction to Human Body

Structures and Functions

Optimal Support

Health Care, Grade 12, College (TPJ4C ¨C 110 hours/1 credit)

This course includes but is not limited to the training elements to have the student reliably demonstrate the ability to

provide client-centred and client-directed care that is based on ethical principles, sensitive to diverse client and

family values, beliefs and needs, and which follows the direction of the of care/service plan. Promote and maintain a

safe and comfortable environment for clients, their families, self and other; assist clients across the lifespan with

routine activities of daily living.

Revised: October 28, 2015

?2014, Queen¡¯s Printer for Ontario

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