Abuse: Domestic, Elder, Child and Sexual

I have read and understand the signs and symptoms of Domestic Violence/Abuse, Elder Abuse, Child Abuse and Sexual Abuse as well as the protocol to follow if suspected, including utilizing the child abuse hotline, 1-800-4-A-CHILD.

Advanced Directives

Advance directives are the legal documents, such as the living will, durable power of attorney and health care proxy, which allow people to convey their decisions about end-of-life care ahead of time. I understand that every patient must be informed of all advanced directives and will make known any advanced directives that the patient does have.

Age Specific Statement

I comply with the age-specific job requirements mandated by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) compliance standards for the following age groups:

  • Neonates
  • Preschool
  • Young Adults
  • Infants
  • School Age
  • Middle Adults
  • Toddlers
  • Adolescents
  • Geriatrics


Bloodborne Pathogens and Needlestick Prevention

I have read and understand the OSHA guidelines for Blood Borne Pathogens and Needlestick Prevention listed @ http://www.osha.gov/SLTC/bloodbornepathogens -1910.1030

Harassment Policies

I have read and understand the Arbor Medical Staffing Harassment Policy and know the reporting procedure to take if I feel harassment exists in the work place.

Environmental and Fire Safety

I have read and understand the protocols to follow to prevent hazards regarding, Fire, Electrical and Environmental surrounding and maintaining a safe work place.

Hazardous Communications and Chemicals

I have read and understand the protocols to follow for hazardous materials according to the Occupational Safety and Health Administration (OSHA) and the Material Safety Data Sheet (MSDS) for chemicals.


I have read and understand the “Health Insurance Portability and Accountability Act” and understand the compliance protocol.

Infectious Disease Control

I have read and understand the Infection Control Guidelines from the Department of Health and Human Services as listed on the Centers for Disease Control and Prevention at http://www.cdc.gov/ncidod/dhqp/guidelines.html .

Patient Rights and Responsibilities

I have read and understand the Patient’s Bill of Rights that was adopted in 1973 by the American Hospital Association and is monitored by the Joint commission on Accreditation of Healthcare Organizations (JCAHO) to ensure the patient’s right to receive healthcare is honored by healthcare facilities and healthcare workers.

Physical Restraints Acknowledgement

I have read and understand the current protocols and regulations regarding physical restraints, their use and misuse.

Assist Medical Staffing has provided me with training, manuals, advice, instructions or documentation of all of the above OSHA and JCAHO material.

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Signature Certificate
Document name: OSHA
lock iconUnique Document ID: 36b90fba1799c1e71e32018bb095e818862628e9
Timestamp Audit
January 24, 2023 4:48 pm EDTOSHA Uploaded by Assist Medical Staffing - staff@assistms.com IP
February 6, 2023 1:18 pm EDT Document owner richard@assistms.com has handed over this document to staff@assistms.com 2023-02-06 13:18:19 -