Faculty of Health and Environmental Sciences Essential Compliance Process

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FACULTY OF HEALTH AND ENVIRONMENTAL SCIENCES

Essential Compliance Process

PART Health Conduct & Fitness


ONE A - Conduct Declaration
B - Health & Fitness Declaration
Option 2

Health Conduct & Fitness

A - Conduct Declaration
investigation declaration
Have you ever been convicted of a criminal and/or been subject to disciplinary proceedings of a
tertiary institution or employer? (please include all criminal matters including
Yes I No
If yes, please give details including dates of any disciplinary proceedings, convictions (or pending) and
any sentence imposed.

Note: If you are in any doubt concerning the appropriate responses to the questions in this section, you are strongly
recommended to seek advice from the Faculty of Health and Environmental Sciences Compliance Office and/or appropriate
registering professional body. Failure to declare any relevant matter may lead to your exclusion from any programme of study
for which you are accepted.

B - Health & Fitness Declaration


Have you ever been diagnosed with, or assessed as having a health condition or impairment which
may either limit your ability to undertake the requirements of the programme, or which may require
adaptations to the workplace or work procedures, to enable you to undertake the requirements of the
programme in a manner which is safe for you and others?

Yes ✓ No
If yes, please give details below including any accommodations that would be required to enable you to
undertake the programme of study:

Note: It is important that this section is filled out correctly and truthfully. Failure to declare any relevant matter may lead to
your exclusion from any programme of study for which you are accepted. The information will be used to ensure all successful
applicants are provided with the appropriate support. You may seek advice from the compliance team who will, if necessary,
act as advocate or facilitator in your interest. Email [email protected]

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A - Safety Checking
The Faculty of Health and Environmental Sciences requires all applicants applying for programmes
responsible to the HPCA Act (2003) and/or Children’s Act (2014), to declare any criminal or
disciplinary charges they have faced, or are facing, and any health status issues which could their
participation in clinical aspects of the programme or their overall fitness to practice.

This process may also be activated at paper enrolment level when students are undertaking
study or experience that involves working with the public.

Children’s Act (2014) Safety Checking Form


The Children’s Act (2014) requires that all people who work or are likely to work with children must
be safety checked. The University is obliged to safety check students for all clinical health
professional training programmes.

In order to assess your safety under the Children’s Act (2014), we need you to complete all the
following questions.

The information you provide will be kept securely, with access strictly controlled and limited to
those who are entitled to see it as part of their duties. The Children’s Act (2014) also requires a
stringent Police Vetting.

*Name: May Myat Mon

*Student ID: 20108342


*Date of birth: 21.09.1997

Any other names you are known by: Em

*Programme(s) you have applied to: Graduate Diploma in Sports and Exercise Science

*Denotes a mandatory field

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DECLARATION

I solemnly and sincerely declare that to the best of my knowledge and belief the information given
within this form is true and correct. I understand that giving a false declaration or failing to disclose all
information may prevent me from gaining registration with the registering authority, or gaining access to
practicum activities and may result in me being withdrawn or declined from the programme.

*Signature:
por *Date: 19/10/2020

*Denotes a mandatory field

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