PY 2022 Job Corps Health and Wellness Center Monthly Staffing

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* 1. Center Name

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* 2. Region

Atlanta

Boston

Chicago

Dallas

Philadelphia

San Francisco

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* 3. Contracted OBS

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* 4. Center Current OBS

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* 5. Your Name

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* 6. Your Title

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* 7. Your Email Address

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* 8. Reporting Period

July 2022

August 2022

September 2022

October 2022

November 2022

December 2022

January 2023

February 2023

March 2023

April 2023

May 2023

June 2023

Wellness Staffing Center Current Information

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* 9. Position on center: Physician

Not Vacant / On Center

Not Vacant / Off Center

Vacant

N/A

Total hours per week

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* 10. Position on center: Physician Assistant

Vacant

N/A

Not Vacant / On Center.
Total hours per week:

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* 11. Position on center: Nurse Practitioner

Vacant

N/A

Not Vacant / On Center.
Total hours per week:

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* 12. Position on center: Health and Wellness Director

Vacant

N/A

Not Vacant / On Center.
Total hours per week:

For # 13, Other Nursing Staff

Include the total number of hours worked by all other nursing staff (not Nurse Practitioners). Please also list how many hours are held by RNs and how many hours are held by LPNs.

If you have more than one nurse employed in other nursing staff, include the number and positions of nurses employed in the "Notes and Comments" section at the bottom of the survey.

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* 13. Position on center: Other Nursing Staff

Vacant

N/A

Not Vacant / On Center.
Total hours per week:

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* 14. Position on center: Mental Health Consultant

Vacant

Not Vacant / On Center.
Total hours per week:

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* 15. Position on center: TEAP Specialist

Vacant

Not Vacant / On Center.
Total hours per week:

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* 16. Position on center: Dentist

Not Vacant / On Center

Not Vacant / Off Center

Vacant

Total hours per week

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* 17. Position on center: Dental Hygienist

Not Vacant / On Center

Not Vacant / Off Center

Vacant

N/A

Total hours per week

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* 18. Position on center: Dental Assistant

Not Vacant / On Center

Not Vacant / Off Center

Vacant

Total hours per week

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* 19. Position on center: Clerical

Vacant

Not Vacant / On Center.
Total hours per week:

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* 20. Position on center: Health Services Administrator (>700 students)

Vacant

N/A

Not Vacant / On Center.
Total hours per week:

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* 21. Position on center: Mental Health Interns (NOT REQUIRED)

Number of interns currently on center

Hours per week for each intern

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* 22. Position on center: 1) Other

Position Title:

Total Hours Per Week:

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* 23. Position on center: 2) Other

Position Title:

Total Hours Per Week:

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* 24. Position on center: 3) Other

Position Title:

Total Hours Per Week:

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* 25. Position on center: 4) Other

Position Title:

Total Hours Per Week:

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* 26. Position on center: 5) Other

Position Title:

Total Hours Per Week:

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* 27. Are there any waivers in place for Wellness staff (i.e. TEAP Specialist, CMHC, etc)? If yes, please list the position and when the waiver expires

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* 28. Notes and Comments-

This section is for ALL notes and comments. Additionally, if you have any positions which are off center, include that here as well.

Thank you for submitting the quarterly Health and Wellness Center Staffing report.

A confirmation will be sent within the next 15 minutes to the e-mail address supplied above containing the submitted responses.

If you have any questions or concerns, contact Leah Pan at Leah.Pan@humanitas.com.

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* 1. Center Name

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* 2. Region

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* 3. Contracted OBS

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* 4. Center Current OBS

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* 5. Your Name

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* 6. Your Title

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* 7. Your Email Address

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* 8. Reporting Period

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* 9. Position on center: Physician

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* 10. Position on center: Physician Assistant

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* 11. Position on center: Nurse Practitioner

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* 12. Position on center: Health and Wellness Director

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* 13. Position on center: Other Nursing Staff

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* 14. Position on center: Mental Health Consultant

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* 15. Position on center: TEAP Specialist

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* 16. Position on center: Dentist

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* 17. Position on center: Dental Hygienist

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* 18. Position on center: Dental Assistant

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* 19. Position on center: Clerical

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* 20. Position on center: Health Services Administrator (>700 students)

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* 21. Position on center: Mental Health Interns (NOT REQUIRED)

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* 22. Position on center: 1) Other

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* 23. Position on center: 2) Other

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* 24. Position on center: 3) Other

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* 25. Position on center: 4) Other

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* 26. Position on center: 5) Other

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* 27. Are there any waivers in place for Wellness staff (i.e. TEAP Specialist, CMHC, etc)? If yes, please list the position and when the waiver expires

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* 28. Notes and Comments-This section is for ALL notes and comments. Additionally, if you have any positions which are off center, include that here as well.

* 28. Notes and Comments-

This section is for ALL notes and comments. Additionally, if you have any positions which are off center, include that here as well.