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Home » Academics » Departments » Nursing » Faculty Forms

Final Clinical Student Evaluation Forms

Faculty Evaluation Forms:

Clinical Simulation Forms:

Other Forms:

Basic HIPAA Training Read HIPAA Privacy Basics & Intermediate Module
including Information Security Awareness" (17 pages) Print HIPAA Privacy Post test"
and answer the questions. Fill in the date, your name, title (student) and submit to
the Nursing Program Office.

Nursing Adjunct Faculty Handbook 2019-2020

Workers' Compensation Forms-To be completed by the student and instructor and returned to the Nursing Program Office immediately. Instructors are required to contact the course lead instructor or the Nursing Program office at the time the accident/injury/illness occurs.

Although only the first 3 forms should be completed for the school, all forms should be reviewed by the injured party.  If the student is treated at the clinical facility, the 4th form should be completed and submitted as well.

District Injury/Illness report
Employee Claim form, California DWC
Employer's Report of Occupational Injury, form 5020
Anthem Accident Claim Verification form

Reference materials:
Guidelines, California DWC
Instructions for Filing a Claim
Map to ALL other Sharp Occupational Medicine Facilities
Map to Sharp Rees Stealy in La Mesa
MPN Pamphlet
Predesignation Form (DWC Form 9783)

Worker Comp Benefits

Last Updated: 08/16/2019
  • Grossmont
  • Cuyamaca
A Member of the Grossmont-Cuyamaca Community College District