Health and Safety Forms

These Forms are for ALL Allied Health Programs

All forms are in PDF Format
Free Readers available at Adobe Acrobat and Foxit

Mask Fit Testing

Mask Fit Testing Information

 Background Screening

Safety and Certification

Read through the following safety documents.
Safety Certification Instructions
Bloodborne Pathogens Packet
Child Abuse Reporting (scan in)
Elder-Dependent Adult Abuse Reporting (scanin)
Confidentiality Statement (scan in)
Student/Staff Requirements in Health Care Facilities (scan in)
Certification of Instruction in Safety Education (scan in)
Safety Certification PowerPoint
Safety Quiz (Grade, write score, and scan in the Answer Sheet)
Safety Quiz Answers
Make sure you grade and write your score clearly on your quiz before scanning it.

Registered Nursing Student Policy Agreement (turn in to AH Office) RN ONLY
 Vocational Nursing Student Policy Agreement (turn in to AH Office) VN ONLY

Physical Forms

Physical Exam/Immunization Guidelines
Physical Exam Form
Immunization Records Form
Seasonal Influenza Immunization Form
Tdap Form
TB Exam Form
*TB Questionnaire (For Chest X-Rays ONLY)
Seasonal Influenza Declination
Tdap Education
Tdap Declination
Hepatitus B Declination

Clearance Form to Return to School/Clinic

*If you have a TB Chest X-Ray you will need to fill out a TB Questionnaire each year

Looking for somewhere to get your immunizations?
Please be sure to follow the Physical Exam/Immunization Guidelines above carefully!

Your primary physician

Bakersfield College Student Health Center
Physical, TDap, and TB Exams
Click here for more information

Irene Sanchez, M.D. Occupational Medicine
 Physical, Mask Fit, MMR, TB, Influenza, Heb B
Click here for more information

Bakersfield Health Department
Contact them for information
(661) 868-0306 • 1-800-974-2717
Hours are Monday - Friday from 8:00am - 5:00pm
1800 Mt. Vernon Avenue
Bakersfield, CA  93306