​​​Frequently Requested Forms & Documents

 

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In this section, you will find documents used for the Job Corps Health and Wellness program.

• Administrative Forms
• Wellness S​taff Desk Reference ​Guides
• ​General He​​alth
  
• Health Record
• ​Program Compliance Assessments
  
• Standard Operating Proc​edures (SOP) Templates
• Technical Assistance Guides
  

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Administrative Forms

• Job Corps Research Study Submission Form — Part 1: Submission of Concept for Initial Approval
• ​Health and Wellness Student Satisfaction Survey — February 2013
  
• Sample MSWR Student Health Leave Form​​ — July 31, 2024
• ​​Formulario de Separación Médi​ca Con Reinstalación (Spanish)​ — July 31, 2024
  
• ​​Student Death Checklist — June 2024
  
• SPAMIS Medical Separation codes for Job Corps Centers — February 2025 New
  

General Health​

• Student at a Glance (writable) and Example of Student at a Glance​​​
• Suggested Medical Equipm​ent and Sup​plies List — June 2023
• ​Job Corps List of Non-Prescription Medications — August 2019
• Accessing Health Care After Job Corp​s Checklist
  
• Chain of Custody Labels Template New
  

​Health Record

​Medical

• Job Corps Health History Form​ — February 2025 New
  
• Job Corps Physical Examination Form — February 2025 New
  
• Social Intake Form — February 2025 New
  
• SF-600 Chronologic​al Record of Medical Care (PDF format)​
• Job Corps Immunization Forms — September 2021​
  Job Corps Immunization Record, Tuberculin Testing, Chemoprophylaxis for Latent Tuberculosis
  
• Student Transfer Summary Form​ — August 2023
• On Center Lab Results - Point of Care Testing — December 2013
• Off-Center Appointment Verification and Feedback Form — March 2020
  
• HIV Testing Information Sheet
  

​Charting​

• PI 14-33 Authorization to Release Health-care Information and Attachment 14-33a — June 9, 2015
• Quality Assurance Health Record Audit Form — June 2019​

Standard Operating Procedures (SOP) Templates

• Health and Wellness Center Staffing (also available in MS Word format)
  Click here for Sample HWC Staffing SOP​ (includes new Health & Wellness Director title)
• Prescribed Non-controlled Medications (MS Word format)
• Prescribed Controlled Substances (MS Word format)
• Over-the-Counter (OTC) Medications (also available in MS Word format)

​​​Technical Assistance Guides (TAGs)

​Centers should maintain a copy of each Technical Assistance Guide (TAG) on file for reference.

• Health Care Guidelines and Written Instructions
  Release Date: August 2021
  Versions: PDF format​ or online​
• Immunization Guide TAG
  Release Date: September 2021
  Versions: PDF format or online

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