Trinity College Clinical Placement Form

Trinity College Clinical Placement Application Form

Step 1 of 3

Your Name(Required)

First Last

Your Address

Street Address Address Line 2 City County Eircode Country

Your Email Address(Required)

Email Address Confirm Email Address

Phone

Emergency Contact Person Name(Required)

Emergency Contact Person Phone No:(Required)

Your Current Position/Discipline(Required)

Course Title(Required)

Name of Contact Person in Trinity College(Required)

Contact No for Person in Trinity College(Required)

Email for Contact Person in Trinity College(Required)

Start Date

End Date

Number of hours for placement

Preferred Location(Required)

*We will endeavour to facilitate your preferred location, but this may not always be possible.

Days Preferred(Required)

*We will endeavour to facilitate your preferred days, but this may not always be possible

What do you hope to achieve from this placement?

Professional Registration/Student Registration Certificate. Please Upload File Below.(Required)

Max. file size: 50 MB.

HSELand AMRIC Standard and Transmission Based Precautions, dated within the last 2 years. Upload Certificate(Required)

Max. file size: 50 MB.

HSELand AMRIC Hand Hygiene Training, dated within the last 2 years. Upload Certificate(Required)

Max. file size: 50 MB.

HSELand Fundamentals of GDPR Training .Upload Certificate(Required)

Max. file size: 50 MB.

HSELand An Introduction to Childrens First Training- dated within the last 2 years. Please Upload Certificate(Required)

Max. file size: 50 MB.

Safeguarding Podcast (25 minutes long). Please watch and then answer questions below Safeguarding Podcast

1. Who is responsible for Child Safeguarding in St Francis Hospice(Required)

Can children play unsupervised in the playrooms of the Hospice?(Required)

Case Study 1: What type of abuse is this?(Required)

Do You(Required)

Case Study 2: What are the main issues?(Required)

Do You(Required)

3. What issues, if any do you feel you need further training on the issue of Safeguarding?

Safeguarding - A guideline for Students and Volunteers. Please read and confirm below: Safeguarding- A guideline for Students and Volunteers

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Phone

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