3. First Name *
  4. Last Name *
  5. Section
  6. Home Phone *
  7. Date of Birth*
  8. Email *
  9. Department*
  10. Job Title (eg. Nurse, LPN)*
  11. Separator
  12. Separator
  13. Agency Name:*
  14. Department*
  15. Start Date*
  16. Please select which area you will be working:*
  17. Please select the facility where you will be working:*
  18. Separator
  20. Please Select:*
  21. Captcha Panel
  22. Submit

Thank you for submitting your Orientation Verification Form.

Name *

Home Address *

I have reviewed the following documents as preparation for employment with CHI Saint Joseph Health. The following topics were reviewed:

  • Purpose and Vision
  • Patient Safety and Rights and Error Prevention
  • CHI Saint Joseph Health Foundations
  • Diversity and Inclusion
  • Corporate Responsibility
  • Pathways
  • Infection Control
  • Safety Codes/Environment of Care
  • National Patient Safety Goals