CON Request for Waiver of Faculty Immunizations or CPR Requirements: Difference between revisions
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<td width="60%"><big>'''Request for Waiver of Faculty Immunizations or CPR Requirements'''</big> | <td width="60%"><big>'''Request for Waiver of Faculty Immunizations or CPR Requirements'''</big></td> | ||
<td valign="top" width="40%"><big>Subsection: '''Appendix M'''</big></td> | <td valign="top" width="40%"><big>Subsection: '''Appendix M'''</big></td> | ||
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<td width="60%">Section - | <td width="60%">Section - Appendices</td> | ||
<td width="40%">Originating Date: October | <td width="40%">Originating Date: October 2003</td> | ||
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<td valign="top" width="60%">Responsible Reviewing Agency:<br /><div style="margin-left:3em; line-height:1.2;">Executive Council<br />Faculty Coordinating Council</div></td> | <td valign="top" width="60%">Responsible Reviewing Agency:<br /><div style="margin-left:3em; line-height:1.2;">Executive Council<br />Faculty Coordinating Council</div></td> | ||
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<td>Revised: February | <td>Revised: [[CON Request for Waiver of Faculty Immunizations or CPR Requirements version February 2008|February 2008]]<br />Reviewed: [[CON Request for Waiver of Faculty Immunications or CPR Requirements version May 2016|May 2016]]<br />Revised: March 2018</td> | ||
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<td valign="top">< | <td colspan="2" valign="top">Related documents:<br /><div style="margin-left:3em; line-height:1.2;">4.2.12</div></td> | ||
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<p style="margin-bottom:150px;">I, ________________________________________________, request a waiver of requirements for the following immunization(s) and or CPR | <p style="margin-bottom:150px; max-width:70em !important;">I, ________________________________________________, request a waiver of requirements for the following immunization(s) and/or CPR (please list):</p> | ||
<p style="margin-bottom:150px;">for the following reason(s):</p> | <p style="margin-bottom:150px;">for the following reason(s) (ex. allergy):</p> | ||
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<td> | <td>_______________________________________________</td> | ||
<td width="75px"> </td> | <td width="75px"> </td> | ||
<td>_______________________________</td> | <td>_______________________________</td> | ||
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<tr><td colspan="3">Submit completed/signed form to conrecords@unmc.edu</td></tr> | |||
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<tr><td colspan="3">Note: For recurring requirements, form should be submitted each time requirements comes due.</td></tr> | |||
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Latest revision as of 13:42, October 7, 2019
Home | Appendices |
UNIVERSITY OF NEBRASKA MEDICAL CENTER COLLEGE OF NURSING |
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Request for Waiver of Faculty Immunizations or CPR Requirements | Subsection: Appendix M | |
Section - Appendices | Originating Date: October 2003 | |
Responsible Reviewing Agency: Executive Council Faculty Coordinating Council |
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Related documents: 4.2.12 |
I, ________________________________________________, request a waiver of requirements for the following immunization(s) and/or CPR (please list):
for the following reason(s) (ex. allergy):
_______________________________________________ | _______________________________ | |
Faculty Signature | Date | |
Submit completed/signed form to conrecords@unmc.edu | ||
Note: For recurring requirements, form should be submitted each time requirements comes due. | ||