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Clinical Affiliation Agreement <br />Page 5 of 6 <br />ii.Hepatitis B vaccination program. (29 CFR 1910.1030(f)(2)) <br />iii.Provide a contact with 24-hours availability for notification of intern exposures. <br />Q. Require interns to complete a Tuberculosis (TB) Control Program consistent with the <br />Centers for Disease Control Guidelines for Preventing the Transmission of Tuberculosis <br />in health-care setting, to include: <br />i.Assurance that all interns who participate in clinical experiences are screened for <br />TB prior to any clinical opportunities and annually thereafter. <br />ii.Assurance that all interns have received education and training about TB prior to <br />any clinical opportunities. <br />R. Require interns to maintain current BLS certification through the AHA. <br />S. Require interns to complete instruction and abide by Confidentiality & HIPPA laws. <br />T. Require interns to submit documentation of the following immunization: <br />i.Measles (Rubeola)-Mumps-Rubella (MMR): Proof of two vaccines or a positive <br />titer indicating immunity. <br />ii.Varicella (Chicken Pox): Proof of vaccine or a positive titer indicating immunity. <br />iii.Hepatitis B: Proof of vaccines or Hepatitis B declination form <br />iv. Tuberculosis: Negative skin test, negative chest x-ray or QuantiFERON TB Gold <br />(QFT) blood results. <br />v. Tetanus, Diphtheria & Pertussis (Tdap): Proof of vaccine < 10 years <br />vi. Influenza: Current vaccine for flu season <br />U. Require interns to participate in routine daily duties of the Service Agency, to include: <br />i.Ambulance and equipment check-off <br />ii.Ambulance, equipment, and station maintenance/cleaning <br />iii.In-service training activities <br />iv. Community service and education events <br />V. In the event, the Administrative Agency enters into another clinical affiliation agreement <br />with another private organization; the Administrative Agency will monitor each intern to <br />ensure interns do not sign-up for clinical opportunities with different organizations. <br />W. As stated in NCGS 115D-24 Johnston Community College (JCC) waives immunity from <br />liability for negligence of agents and employees of JCC by obtaining liability insurance <br />as provided in G.S 115D-53 G.S for the death or injury of person or for property damage <br />Docusign Envelope ID: 3F418FE8-2F1F-4667-BBBD-B548F8E3D7F4