Inpatient Checklist for Clinical RN Student Placement

Upon approval complete – GSAA Roster/Health Connect Request Form

Submit your paperwork only after the items below are completed in PDF format for each individual student in the following order:

Make sure that all documents are legible and were filled out using Black or Blue Ink only.    

• Affiliated School Checklist for Students
• Immunization records must be attached per checklist above
• Influenza Vaccine Form
• Hepatitis B Vaccine Consent/Declination Form
• Tetanus, Diphtheria & Pertussis (Tdap) Declination Form
• TB Symptom Questionnaire (not required unless submitting chest x-ray results)
• American Heart Association BLS CPR Certificate (and) Professional License
• Background Check Clearance (actual report)
• Drug Screen Clearance (actual report)

KP Learn Online Training Modules (must include all completed KP Learn Certificates)

MANUAL TESTS (provided by Nursing Professional Development)

• Fall Prevention
• Patient Restraints
• Blood Product Administration

If you have any additional questions, please feel free to reach out to the placement coordinators:

• Student Placement
  Program Coordinator
  Office: 510-675-6844 or 510-675-5739
  Email:  GSAAStudentOnboarding@kp.org
• Gwendolyn Robinson
  Student Liaison – Fremont
  Office: 510-248-7038
  Mobile: 510-846-3960
  Email: Gwenolyn.Q.Robinson@kp.org