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[email protected] (Julianne Esquivias)
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One Car e Hospice, Inc 1
PERSONNEL FILE CHECKLIST
Date of Hire: ___________________________
Employee Name: _________________________________________________________ Position: ________________________
SECTION I
⬜ Application
⬜ Staff Orientation & Training on HIPAA
⬜ Confidentiality Agreement
⬜ Conflict of Interest
⬜ Code of Conduct
⬜ Identifying Types of Abuse & Abuse Reporting
⬜ Role in Patient Rights
⬜ Role in Infection Control
⬜ Acknowledgement and Understanding of Policies
⬜ Universal Precaution
⬜ Injury Prevention
⬜ Business Agreement
- - -
⬜ Job Description
⬜ Orientation Checklist
SECTION II
⬜ Skills checklist
⬜ Performance Evaluation
⬜ Certificate of Education / Trainings or Seminars completed
SECTION III
⬜ Driver’s License (copy)
⬜ Social Security card (copy)
⬜ License / Certificate (copy)
⬜ CPR / First Aid (copy)
⬜ Professional Liability Insurance (copy)
⬜ Background Check
⬜ OIG
CONFIDENTIAL
⬜ Physical/Health Examination
⬜ TB Test/Result
⬜ Flu vaccine
⬜ Hepatitis waiver
⬜ I-9 Form
⬜ W-4 Form
** FOR OFFICE USE ONLY **
This page is to be completed by office personnel