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