Forms

Student Appeals

Refer to our Student Appeals page for more information on undergraduate appeals, which includes Academic Appeals, Practicum Intervention Appeal, and Code of Student Behaviour Appeals. For forms and guides related to student appeals, refer to our Forms and Guides.

Health & Safety

Undergraduate Clinical Forms

Refer to our Health and Safety Document Requirements for more details.

Checklist

Review the Health and Safety Checklist

Final Exam Deferral Form

For more information regarding the process of requesting a deferred final examination, see Final Examination Deferral Student Process under Program Information.

Once you have reviewed this information, you may complete the following:

Course Overload

If you would like to exceed the maximum number of credits allowed by the Faculty of Nursing you will need to request a Course Overload for a given term: Course Overload Form.

NOTE: Course overloads will not be granted in terms with clinical courses.

Letter of Permission

If you would like to take a course at another institution while in the Faculty of Nursing, you must obtain permission from Undergraduate Student Services prior to registration. Your request will be reviewed by a Student Advisor once you submit a request for a Letter of Permission.

NOTE: a Letter of Permission will not be granted in terms with clinical courses.

Leave of Absence

If you would like to take a break from your program for a period of 12 months, you are required to submit a Leave of Absence Request from your program.

NOTE: Leaves of absence can only be granted for one year starting in a Fall term and returning in the following Fall term. If your request would be for alternate terms, contact the student advisor at nursing.studentadvisor@ualberta.ca.

Injury and Incident Reporting

Faculty of Nursing undergraduate students are required to report occasions of injury and other incidents. Routine incident reporting is required for situations of student injury ("workplace injury") or a patient safety incident. Critical incident reporting is required in addition to routine incident reporting in situations of serious risk or harm to a client/patient, student or faculty member.

Directions and forms for reporting are listed below.

Routine Incident Reporting

A) Workplace Injury

If you are injured or are exposed to human blood/body fluids during your clinical practicum let your clinical instructor know immediately. Your instructor will ensure that you receive first-aid treatment immediately and make the charge nurse aware of the incident. You will follow the protocol of the agency in which you are injured.

As a University of Alberta student, you are required to fill out the University of Alberta Incident Report and the University of Alberta "Workers' Report of Injury or Occupational Disease" form for the Workers' Compensation Board-Alberta (WCB). Your instructor has a copy of the WCB forms. The WCB form is time sensitive and must be submitted within 24 hours of the injury occurring.

If you cannot complete all of the information, for example you are not sure of your social insurance number or health care number, send in the document with the information missing. This information can be added later. The forms need to be returned to the Faculty of Nursing. Fax completed forms to: Denise Pasieka, Clinical Placement Coordinator, (780) 492-2551. Ensure that you verify that the forms have been received by sending an email to dmcavoy@ualberta.ca or by calling (780) 492-8645.

B) Patient Safety Incident

You are required to complete the incident report form used by the clinical agency where the patient is situated.

Critical Incident Reporting and COVID-19 Reporting

In situations of serious risk or harm to a client/patient, student or faculty member, and in situations of exposure to COVID-19 and/or if experiencing COVID-19 symptoms you are required to fill out the Faculty of Nursing Critical Incident Report (Google Form).