BETTY WHITE HEALTH CENTER
STUDENT NAME DATE INSTRUCTOR COURSE
| CRITERIA | DATE OF INFRACTION | INSTRUCTOR'S COMMENTS [initials] | STUDENT'S COMMENTS [initials] |
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| I. ARTICLES NEEDED FOR USE WITH UNIFORM |
| A. Watch | | | |
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| B. Scissors | | | |
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| C. Black Ink Pen | | | |
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| E. Penlight | | | |
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| F. Stethoscope | | | |
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| II. PERSONAL HYGIENE |
| A. Appearance – Hair, nails, cosmetics, etc.... | | | |
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| B. Jewelry, tattoos, piercings, etc.... | | | |
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| C. Odor (i.e. tobacco, vape products, cologne, perceptible body odor, etc....) | | | |
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| III. IDENTIFICATION BADGE | | | |
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| IV. UNIFORM |
| A. Scrubs (top/bottom) | | | |
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| B. Laboratory coat | | | |
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| C. Socks/Shoes | | | |
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| D. Solid white t-shirt / undergarments | | | |
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| E. Other attire (i.e. business casual). | | | |
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| V. Other Infractions (i.e. smoking, eating, etc.) | | | |
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| VI. Uniform Utilization | | | |
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