Educational Experience Checklist for Students and On-Site Faculty

Print this attachment and complete the items prior to the first experience at EIRMC. Your instructor must sign the form in the appropriate place.

Instructions for Student Background Check

Your school may be able to provide a signed attestation form (Exhibit C) if you have already completed a recent (less than one year) background check. Contact your school for details.

If you are under 18 years old, please contact your instructor for specific details about obtaining a background check. Do not use the online submission form.

Background checks are required on incoming students to insure the safety of the patients treated by students in the clinical education program. You will be required to order your background check in sufficient time for it to be reviewed by the program coordinator or associated hospital prior to starting your clinical rotation. A background check typically takes 3-5 normal business days to complete. The background checks are conducted by PreCheck, Inc., a firm specializing in background checks for healthcare workers. Your order must be placed online through StudentCheck.

Go to My Student Check and select your School and Program from the drop down menus for School and Program. It is important that you select your school worded as Eastern Idaho Regional Medical Center - Students

Please open the attachment for instructions and Frequently Asked Questions.

If you need further assistance, please email PreCheck.

Student/Faculty On-Site Health Questionnaire

Print this form, fill out the demographic information and sign the form. You must provide the appropriate documentation of the specific health items requested along with the form.

Confidentiality and Security Agreement

Print this form. Sign the form and print your name in the appropriate boxes. The “Facility Name” is EIRMC and the “Business Entity Name” is the school you are affiliated with.

Parking Acknowledgement Form

Open the link, and print the form. Carefully review the information included in the EIRMC Parking Policy. Sign and date the form.

Safety & Compliance

Review this document carefully, for competencies such as fire safety, disaster planning, electrical and oxygen safety, HIPPA compliance, back safety, and infection control. Please sign the attestation on page 1 to document your understanding of the education.

Exhibit A, Statement of Responsibility

Print this form, enter the name of your school in the first blank. then you will need to sign and date it. If you are under the age of 18 your parent or legal guardian must sign and date this form and then you can submit this form.