Grady Health System & Grady Infectious Disease

Student Information

  1. Complete General Orientation Training

  2. General Orientation Training Record

    1. Name: Print your name    

    2. Phone Number: Your day time telephone number

    3. Company Name:  Leave Blank 

    4. School Name: Kennesaw State University

    5. Area/Dept. Working in: Pick your assigned department (OB, Infectious Disease, Grady Neighborhood Center, HIV, Mental Health, Med Surg.)

    6. Grady Contact Name: Linda O’Sullivan   Start & End Date: Leave Blank    Grady Contact Phone: 404-616-5394

    7. Numbers 1-9 enter your name and completion date. 

      Each box MUST be signed and dated, do not fax document

    8. Print and sign your name and date

  3. Corporate Compliance Program

    1. Signature: Sign your name

    2. Department: Enter Area/Dept. Working in from letter “e” from step 2 above

    3. Print Employee Name: Print your Name

    4. Position/Title:  Nursing Student

    5. Date: Todays Dates 

    6. Employee ID #: KSU ID #

  4. Customer Service Agreement for General Orientation

    1. Signature: Sign your name

    2. Print Name: Print your name

    3. Company Name: Kennesaw State University

    4. Supervisor Name: Leave Blank

    5. Telephone #: Day time telephone #

    6. Date: Todays Date

  5. Confidentiality and Non-Disclosure Statement

    1. Signature: Your signature  

    2. Date: todays date

    3. Name: Print your Name  

    4. Department/Location: Enter Area/Dept. Working in from letter “e” from step 2 above

  6. Corporate Responsibility Standards Certification Statement

    1. Initial Numbers 1-5

    2. Signature: Sign your name

    3. Department: Enter Area/Dept. Working in from letter “e” from step 2 above

    4. Print Employee Name: Print your name

    5. Position Title: Nursing Student

    6. Date: todays date

    7. Employee ID Number: KSU ID#

  7. Computer System Acceptable Use Agreement

    1. Printed Name: Print Your Name

    2. Signature: Your Signature

    3. Last four digits of SSN: last four digits of your SS#

    4. Title: Nursing Student

    5. Todays Date: Todays Date

    6. Affiliation: Check Other and write Nursing Student

    7. Organization / Department Name:  Kennesaw State University

    8. HR ID: Leave Blank

  8. If your enrolled in Mental Health (course 3314) or Maternal Child (course 3318): In addition to completing the General Orientation Training, you must complete:

    1. Women / Infant Health Services Consent Form Addendum

      • Complete the form in its entirety

    2. GAPS

      • Sign and date

    3. Log into your Advantage account and select Grady Health System to view your results  

 

 

Document Checklist:

 

General Orientation Training Record (1 page)

Corporate Compliance Handout (CC handout) (1 page)

Customer Service Agreement for General Orientation (1 page)

Confidentiality and Non-Disclosure Statement (1 Page)

Risk Management Department Fall Injury Prevention & Management Post Test – Quiz Only (Answers are highlighted in yellow, circle the corresponding letter for answer) (1 page)

Corporate Responsibility Stands Certification Statement (1 page)

IS Acceptable Use Agreement (1 page)

Women/Infant Health Services Consent Form Addendum (3314 & 3318 students only)  (1page)

GAPS (3314 & 3318 Students only) (1 page)