Orientation handbook

Appendix A Clinical 
Rotation Form
 
Facility: 

FMH 

SJB

SJE

SJH 

SJJ

SJL

SJMS Unit Assigned:_______ 
Program: 

Clinical

Preceptorship 
**
Total Hours
:_______
Arrival Date: 
Completion Date:
Clinical Instructor/Faculty: 

New 

Returning 
Email Address: 
Time Range of Day on unit:
Days of week on unit: Mon______ Tue______ Wed______ Thu ______Fri_____ Sat______ 
Phone# Work: _______________________________ Home: ____________________________ 
Pager: ______________________________ Cell: ______________________________ 
PLEASE PRINT ANOTHER COPY IF YOU HAVE MORE STUDENT NAMES TO ADD
STUDENTS 
(Print Full Name) 
Email Address 
Phone # 
Flu Vaccine 
Yes/No/ 
Date 
Academic Level
1
st
 yr, 2
nd
 yr, 3
rd
 
yr
Sr. yr
Confidentiality & 
Orientation
Form Received Date
 

---

5 
 
 
 
Appendix B 
Clinical Faculty
Acknowledgment of Orientation
I have read the faculty orientation handbook and reviewed the 
Our Values and Ethics at Work 
electronic booklet 
located on the https://insidesaintjoseph.org/Nursing/Resources 
 
web page and the 
2019 Safety Booklet 
information located in the Faculty handbook. 
I understand the expectations and I agree to abide by Hospital policy, protocols, and standards of practice 
during my clinical facilitation at