​​​Frequently Requested Forms & Documents

 

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

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

• Administrative Forms
• Wellness S​taff Desk Reference ​Guides
• Federal Directives and Notices
  • Information Notices
• PRH Change Notices​
• Program Instruction Notices
• Job Corps Data Center Notices
• General He​​alth
• Health Record
• Ne​wsletters
  
• Program Compliance Assessments
  
• Standard Operating Proc​edures (SOP) Templates
• Technical Assistance Guides
• Annual Health & Wellness Reports​​
  

---

Administrative Forms

• Job Corps Research Study Submission Form — Part 1: Submission of Concept for Initial Approval
• ​Health and Wellness Student Satisfaction Survey — February 2013
  
• Student Tran​sfer Summa​ry Form​ — August 2023
• Sample MSWR Student Health Leave Form​​ — July 31, 2024 Updated
• ​​Formulario de Separación Médi​ca Con Reinstalación (Spanish)​ — July 31, 2024 Updated
• ​​Student Death Checklist — June 2024 Updated
  

General Health​

• Student at a Glance (writable) and Example of Student at a Glance​​​
• SPAMIS Medical Separation Codes for Job Corps Centers​ — May 2023
  
• Suggested Medical Equipm​ent and Sup​plies List — June 2023
  
• Suggested Dental Equipment List and Specifications​ (includes Aerosol Containment Add​itions) — June 29, 2023
• Job Corps List of Non-Prescription Medications — August 2019

Health Record

​Medical

• Job Corps Health History Form Instructions
• Job Corps Health History Form
• Health History Form with no header
• Job Corps Physical Examination Form — June 2013
• ETA 6-53 Job Corps Health Questionnaire — March 2024
  
• ETA 6-53 Guide for Admissions Services — Dece​mber 2024 Updated
• 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
  
• Social Intake Form — October 2012
• Student Transfer Summary C​hecklist — June 2019
• On Center Lab Results - Point of Care Testing — December 2013
• Off-Center Appointment Verification and Feedback Form — March 2020
  
• HIV Testing Information Sheet
  

Dental

• Job Corps Oral Examination Record Form — June 2013
• Job Corps Oral Examination Record Instructions — June 2013

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.

• ​​Family Planning TAG
  Release Date: July 2020
  Versions: PDF format​ or online
• 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
• Sexual Assault Prevention and Response TAG
  Release Date: August 2021
  Versions: PDF format or online ​​
  
  

Return to top​​​​​​