• Deer Valley Unified School District HEALTH AND SAFETY REQUIREMENTS




    1. MMR (Measles/Rubeola, Mumps, & Rubella)

    MMR is a combined vaccine that protects against three separate illnesses – measles, mumps and rubella (German measles) – in a single injection. Measles, mumps, and rubella are highly infectious diseases that can have serious, and potentially fatal, complications. The full series of MMR vaccination requires two doses.

    If you had all three illnesses OR you have received the vaccinations but have no documented proof, you can have an IgG MMR titer drawn, which provides evidence of immunity to each disease. If the titer results are POSITIVE, showing immunity to each disease, submit a copy of the lab results.

    Options to meet this requirement:

    1. Submit documentation of two MMR vaccinations on separate dates at least 4 weeks apart.


    1. Lab documentation of POSITIVE titer results for each disease (measles, mumps and rubella).
    2. NEGATIVE or EQUIVOCAL titer results for measles, mumps or rubella shows lack of immunity, meaning you must Submit documentation of one MMR booster (vaccination) dated after negative or equivocal titer.


    2. Varicella (Chickenpox)

    Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). Infection with chickenpox also makes people susceptible to develop herpes zoster (shingles) later in life. The best means of preventing chickenpox is to get the varicella vaccine.

    Varicella vaccination is required for all healthcare workers who do not meet evidence of immunity by having met any of the following criteria: a). Documentation of receiving 2 doses of varicella vaccine, separated by at least 4 weeks or b). Laboratory evidence of immunity or laboratory confirmation of disease. If you haven't had the varicella vaccine or if you don't have a blood test that shows you are immune to varicella (i.e., no serologic evidence of immunity or prior vaccination) get 2 doses of varicella vaccine, 4 weeks apart.

    Options to meet this requirement:

    1. Documentation of two varicella vaccines, including dates of administration.


    1. Submit a copy of proof of a POSITIVE IgG titer for varicella. If the titer is NEGATIVE or EQUIVOCAL. Submit documentation of one varicella (vaccination) booster dated after negative or equivocal titer.


    3. Tetanus/Diphtheria/Pertussis (Tdap):

    Tetanus, diphtheria, and pertussis are serious bacterial illnesses which can lead to illness and death. Tdap vaccination can protect against these diseases and is recommended for healthcare personnel with direct patient contact who have not previously received Tdap. Tdap vaccination can protect healthcare personnel against pertussis and help prevent them from spreading it to their patients.

    The Td vaccine protects against tetanus and diphtheria, but not pertussis. Following administration of Tdap, a Td booster should be given if 10 years or more since the Tdap. Tdap may be given as one of these boosters if you have never gotten Tdap before. Tdap can be administered regardless of interval since the previous Td dose.

    To meet this requirement:

    Provide documentation of a Tdap vaccination administered after the age of 11 and then a Td vaccination every 10 years thereafter.


    4. Tuberculosis (TB)

    Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis which usually infects the lungs, but can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria develops tuberculosis. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. If not treated properly, TB disease can be fatal.

    All students entering a DVUSD program are required to submit documentation showing negative TB disease status. Documentation may include a negative 2-step Tuberculosis Skin Test (TBST) or negative blood test (QuantiFERON or T-Spot) performed within the previous six (6) months. The TBST or negative blood test must remain current throughout the semester of enrollment.

    To maintain compliance with annual TB testing requirements, students who initially submitted a 2-step TBST may submit a current 1-step TBST for subsequent annual testing. A TBST is considered current if no more than 365 days have elapsed since the date of administration of the second of the 2-step TBST. Most recent skin testing or blood test must have been completed within the previous six (6) months.

    If you have ever had a positive TBST, you must provide documentation of a negative blood test or negative chest X-ray. You will also need to complete a TB Symptom Screening Questionnaire annually.

    To meet this requirement:

    1. Proof of a negative 2-step TBST completed within the previous 6 months, including date given, date read, result, and name and signature of the healthcare provider. A 2-step TBST consists of an initial TBST and a boosted TBST 1-3 weeks apart.


    1. Submit documentation of a negative blood test (QuantiFERON or T-Spot) performed within the last six months.


    1. Submit documentation of a negative chest X-ray if TBST or Blood Testing is positive.
    2. POSITIVE RESULTS: If you have a positive TBST, provide documentation of negative chest X-ray or negative blood test



    5. Hepatitis B

    DVUSD Nursing students may be exposed to potentially infectious materials which can increase their risk of acquiring hepatitis B virus infection, a serious disease that can cause acute or chronic liver disease which can lead to a serious, lifelong illness. DVUSD Nursing recommends that all students receive the hepatitis B 3-vaccine series administered over a 6 month period. Obtain the first vaccination; the second is given 1 - 2 months after the first dose and the third injection is 4 - 6 months after the first dose.

    Effective immunization status can be proven by a titer confirming the presence of anti-Hbs or HepBSab antibodies in the blood. This titer is recommended but not mandatory.

    Students may choose to decline the hepatitis B vaccine; however, lack of immunity to hepatitis B means that students remain at risk of acquiring the disease.

    Options to meet this requirement:

    1. Submit a copy of laboratory documentation of a positive HbsAb titer.


    1. Submit a copy of your immunization record, showing completion of the three Hepatitis B injections. If the series is in progress, submit a copy of the immunizations received to date. You must remain on schedule for the remaining immunizations and provide the additional documentation. One to two months after your last immunization, it is recommended that you have an HbsAb titer drawn.


    1. Submit a copy of your signed Hepatitis B declination noting that by declining the vaccine you continue to be at risk of acquiring hepatitis B, a serious disease.


    6. Influenza (Flu Vaccine)

    Influenza is a serious contagious respiratory disease which can result in mild to severe illness. Susceptible individuals are at high risk for serious flu complications which may lead to hospitalization or death.

    The single best way to protect against the flu is annual vaccination. A flu vaccine is needed every season because: 1). The body's immune response from vaccination declines over time, so an annual vaccine is needed for optimal protection; 2). because flu viruses are constantly changing, the formulation of the flu vaccine is reviewed each year and sometimes updated to keep up with changing flu viruses. The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season.

    Students are required to be vaccinated every flu season and to submit documentation proving annual vaccinations.

    To meet this requirement:

    Submit a copy of proof of flu vaccine proving annual vaccination.


    7. CPR (Basic Life Support) Certification

    CPR is a procedure performed on persons in cardiac arrest in an effort to maintain blood circulation and to preserve brain function. DVUSD Nursing students are required to learn CPR by completing an acceptable Basic Life Support course. CPR certification must include infant, child, and adult, 1-and 2-man rescuer, and evidence of a hands-on skills component.

    CPR courses are offered at numerous locations throughout the greater Phoenix area. The American Heart Association provides in-person courses and an online course. Students who complete online courses must complete the hands-on skills training and testing. CPR training without the hands-on skills training and testing component will not be accepted.

    Students are required to maintain current CPR certification throughout enrollment in the nursing program.

    To meet this requirement:

    Submit a copy of the signed CPR card (front and back) or CPR certificate.



    8. Health Care Provider Signature Form

    Must be completed and signed by a licensed healthcare provider (M.D., D.O., N.P., P.A.) within the past six (6) months.

    1. Submit a copy of DVUSD athletic clearance for


    1. Submit a copy of DVUSD Introduction to Nursing (CAN) Medical Clearance form

    To meet this requirement:

    Submit a copy of the signed Health Care Provider Signature form completed within the past six (6) months.


    9. Proof of Health Care Insurance

    Proof of health care insurance. Students are required to maintain current health care insurance throughout enrollment of the nursing program.

    To meet this requirement:

    Submit a copy of health care insurance card.  


    10. Entrance Math/English Exam

    All students admitted to DVUSD Nursing are required to show a "Pass" result on the DVUSD Entrance Math/English Exam completed through Canvas. You will need to self-enroll at: https://dvusd.instructure.com/enroll/KPLYR8

    To meet this requirement:

    Complete the DVUSD Entrance Math/English Exam



    11. Background Clearance Document

    All students admitted to DVUSD Nursing are required to show a "Pass" result on the DVUSD -required supplemental background screening completed within the first week of class. Information regarding the background clearance is obtained from DVUSD Nursing following your acceptance into the nursing program.

    To meet this requirement:

    Submit a completed DVUSD background information sheet





    • Healthcare students have a responsibility to protect themselves and their patients and families from preventable diseases.


    • Students are responsible for maintaining all health and safety requirements and to submit documentation by due date. Failure to maintain program health and safety requirements will result in inability to continue clinical experiences and may result in withdrawal from the nursing program.


    • All immunization records must include student name and the signature of healthcare provider.


    • Health and safety requirements are subject to change depending on clinical agency requirements.





    Health and Safety Requirements Student Worksheet

    Use this worksheet as a guide to ensure that you have documentation of each requirement. DO NOT submit this document. Only supporting documents (lab results, immunization records, signed healthcare provider form, etc.) for each requirement should be submitted.


    MMR (Measles/Rubeola, Mumps and Rubella) To meet requirement:

    1. MMR vaccination: Dates: #1__________ #2__________


    1. Date & titer results:

    Booster: ___________

    Measles: ___________ _____________

    Mumps: ___________ _____________

    Rubella: ___________ _____________


    Varicella (Chickenpox) To meet requirement:

    1. Varicella vaccination dates: #1__________ #2__________


    1. Date & results of varicella IgG titer: Date: ___________ Result: ______________, Booster: ___________


    Tetanus/Diphtheria/Pertussis (Tdap) To meet requirement:

    Tdap vaccine: Date: ___________

    Td booster: Date: ___________


    Tuberculosis To meet requirement:

    1. Negative 2-step TB Skin Test (TBST), including date of administration, date read, result, and name and signature of healthcare provider.

    Initial Test (#1) Date: __________ Date Read: __________ Results: Negative or Positive

    Boosted Test (#2) Date: __________ Date Read: __________ Results: Negative or Positive

    1. Annual 1-step TBST (accepted only from continuing students who have submitted initial 2-step TBST)

     Date: __________ Date Read: __________ Results: Negative or Positive


    1. Negative blood test (Either QuantiFERON or TSpot)

    QuantiFERON Date: __________

    T-Spot Date:_________


    1. Negative chest X-ray


    1. Documentation of a negative chest X-ray (x-ray report) or negative QuantiFERON result.

    Date: __________


    Hepatitis B To meet requirement:

    1. Positive HbsAb titer Date: __________ Result: _____


    1. Proof of 3 Hepatitis B vaccinations

    Hepatitis B vaccine/dates: #1__________ #2__________ #3__________


    1. Hepatitis B declination- students who choose to decline Hepatitis B vaccine series must submit a HBV Vaccination Declination form.


    Flu Vaccine To meet requirement:

    Documentation of current annual flu vaccine Date: __________


    CPR Card (Healthcare Provider level) To meet requirement:

    CPR card or certificate showing date card issued: __________ Expiration date: __________


    Background Clearance Document To meet requirement:

    DVUSD Background check form filled out, signed and dated


    Health Care Provider Signature Form To meet requirement:

    Healthcare Provider Signature Form signed and dated by healthcare provider. Date of exam: __________


    Proof of Health Care Insurance To meet requirement:

    Coverage dates: __________





    Background Clearance Document


    Full Legal Name

    First ________________________________ Middle ____________________ Last _________________________


    Social Security Number



    All students admitted to DVUSD Nursing are required to show a "Pass" result on the DVUSD -required supplemental background screening completed within the first week of class. Information regarding the background clearance is obtained from DVUSD Nursing following your acceptance into the nursing program.


    I (student name) ___________________________ understand and allow DVUSD nursing to run a background check. I understand my background check must show “Pass” to be allowed to participate in DVUSD Nursing program.

    Student Print Name                                                                        Student Signature


    ___________________________________________      ____________________________________ Date____________


    Parent / Legal Guardian Print Name                                         Parent / Legal Guardian Signature


    ___________________________________________      ____________________________________ Date____________





    Instructions for Completion of Healthcare Provider Signature Form


    A healthcare provider must sign the Healthcare Provider Signature Form within six (6) months of program admission and indicate whether the applicant will be able to function as a nursing student. Health care providers who qualify to sign this declaration include a licensed physician (M.D., D.O.), a nurse practitioner (N.P.), or physician’s assistant (P.A.).


    (Please Print)

    Applicant Name: _____________________________________ Student ID Number: _______________________


    It is essential that nursing students be able to perform a number of physical activities in the clinical portion of the program. At a minimum, students will be required to lift patients, stand for several hours at a time and perform bending activities. Students who have a chronic illness or condition must be maintained on current treatment and be able to implement direct patient care. The clinical nursing experience also places students under considerable mental and emotional stress as they undertake responsibilities and duties impacting patients’ lives. Students must be able to demonstrate rational and appropriate behavior under stressful conditions. Individuals should give careful consideration to the mental and physical demands of the program prior to making application.


    I have reviewed the DVUSD Essential Skills and Functional Abilities. I believe the applicant:


    ______ WILL ______WILL NOT be able to function as a nursing student as described above.


    If not, explain:







    Licensed Healthcare Examiner (M.D., D.O., N.P., P.A.):

    Print Name: _____________________________________________ Title: ________________________


    Signature: _______________________________________________ Date: ________________________


    Address: ______________________________________________________________________________


    City: _____________________________ State: _______________ Zip Code: __________________


    Phone: _____________________________





    Essential Skills and Functional Abilities for Nursing Students

    Individuals enrolled in DVUSD Nursing must be able to perform essential skills. If a student believes that he or she cannot meet one or more of the standards without accommodations, the nursing program must determine, on an individual basis, whether a reasonable accommodation can be made. The ultimate determination regarding reasonable accommodations will be based upon the preservation of patient safety.





    Examples Of Required Activities





    Physical abilities and mobility sufficient to execute gross motor skills, physical endurance, and strength, to provide patient care.



    • Mobility sufficient to carry out patient care procedures such as assisting with ambulation of clients, administering CPR, assisting with turning and lifting patients, providing care in confined spaces such as treatment room or operating suite.





    Demonstrate fine motor skills sufficient for providing safe nursing care.


    • Motor skills sufficient to handle small equipment such as insulin syringe and administer medications by all routes, perform tracheotomy suctioning, insert urinary catheter.






    Sensory/perceptual ability to monitor and assess clients.


    • Sensory abilities sufficient to hear alarms, auscultory sounds, cries for help, etc.

    • Visual acuity to read calibrations on 1 ml syringe, assess color (cyanosis, pallor, etc.).

    • Tactile ability to feel pulses, temperature, palpate veins, etc.

    • Olfactory ability to detect smoke, odor, etc.





    Ability to relate to colleagues, staff and patients with honesty, civility, integrity and nondiscrimination. Capacity for development of mature, sensitive and effective therapeutic relationships. Interpersonal abilities sufficient for interaction with individuals, families and groups from various social, emotional, cultural and intellectual backgrounds. Ability to work constructively in stressful and changing environments with the ability to modify behavior in response to constructive criticism. Negotiate interpersonal conflict. Capacity to demonstrate ethical behavior, including adherence to the professional nursing and student honor codes.


    • Establish rapport with patients/clients and colleagues.

    • Work with teams and workgroups.

    • Emotional skills sufficient to remain calm in an emergency situation.

    • Behavioral skills sufficient to demonstrate the exercise of good judgment and prompt completion of all responsibilities attendant to the diagnosis and care of patients.

    • Adapt rapidly to environmental changes and multiple task demands.

    • Maintain behavioral decorum in stressful situations.




    for patients,

    families and



    Ability to accurately identify patients. Ability to effectively communicate with other caregivers. Ability to administer medications safely and accurately. Ability to operate equipment safely in the clinical area. Ability to recognize and minimize hazards that could increase healthcare associated infections. Ability to recognize and minimize accident hazards in the clinical setting including hazards that contribute to patient, family and co-worker falls.


    • Prioritizes tasks to ensure patient safety and standard of care.

    • Maintains adequate concentration and attention in patient care settings.

    • Seeks assistance when clinical situation requires a higher level or expertise/experience.

    • Responds to monitor alarms, emergency signals, call bells from patients, and orders in a rapid and effective manner.




    Ability to communicate in English with accuracy, clarity and efficiency with patients, their families and other members of the health care team (including spoken and non-verbal communication, such as interpretation of facial expressions, affect and body language). Required communication abilities, including speech, hearing, reading, writing, language skills and computer literacy. Communicate professionally and civilly to the healthcare team including peers, instructors, and preceptors.


    • Gives verbal directions to or follows verbal directions from other members of the healthcare team and participates in health care team discussions of patient care.

    • Elicits and records information about health history, current health state and responses to treatment from patients or family members.

    • Conveys information to clients and others to teach, direct and counsel individuals in an accurate, effective and timely manner.

    • Establishes and maintain effective working relations with patients and co-workers.

    • Recognizes and reports critical patient information to other caregivers.




    Quantitative Abilities



    Ability to read and understand written documents in English and solve problems involving measurement, calculation, reasoning, analysis and synthesis. Ability to gather data, to develop a plan of action, establish priorities and monitor and evaluate treatment plans and modalities. Ability to comprehend threedimensional and spatial relationships. Ability to react effectively in an emergency situation.


    • Calculates appropriate medication dosage given specific patient parameters.

    • Analyze and synthesize data and develop an appropriate plan of care.

    • Collects data, prioritize needs and anticipate reactions.

    • Comprehend spatial relationships adequate to properly administer injections, start intravenous lines or assess wounds of varying depths.

    • Recognizes an emergency situation and responds effectively to safeguard the patient and other caregivers.

    • Transfers knowledge from one situation to another.

    • Accurately processes information on medication container, physicians’ orders, and monitor and equipment calibrations, printed documents, flow sheets, graphic sheets, medication administration records, other medical records and policy and procedure manuals.



    work habits


    Ability to adhere to DVUSD Nursing policies, procedures and requirements as described in the Student Nurse Handbook, college catalog and student handbook and course syllabus. Ability to complete classroom and clinical assignments and submit assignments at the required time. Ability to adhere to classroom and clinical schedules.


    • Attends class and submits clinical assignments punctually.

    • Reads, understands and adheres to all policies related to classroom and clinical experiences.

    • Contacts instructor in advance of any absence or late arrival.

    • Understands and completes classroom and clinical assignments by due date and time.



    Recognize the personal risk for exposure to health hazard. Use equipment in laboratory or clinical settings needed to provide patient care. Tolerate exposure to allergens (latex, chemical, etc.). Tolerate wearing protective equipment (e.g. mask, gown, gloves)


    • Takes appropriate precautions for possible exposures such as communicable disease, bloodborne pathogens, and latex.

    • Uses personal protective equipment (PPE) appropriately.