[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-270639-105":59,"doc-detail-270639-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","decline-to-vaccinate-form-faculty-of-health-work-integrated-learning-wil-placement","Decline to Vaccinate Form - Faculty of Health Work-Integrated Learning (WIL) Placement","","Decline to Vaccinate Form for Charles Darwin University (CDU) Faculty of Health Work-Integrated Learning (WIL) placements explains immunisation compliance requirements for students who choose not to be vaccinated or who cannot provide vaccination/immune status evidence. It outlines the health and safety rationale for mandatory vaccination due to increased occupational exposure to biologically infectious material during placement, possible impact on placement opportunities, and risks of extending course duration. The form captures student details, declarations, course coordinator guidance, and required signatures for processing in InPlace.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/decline-to-vaccinate-form-faculty-of-health-work-integrated-learning-wil-placement/270639/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/decline-to-vaccinate-form-faculty-of-health-work-integrated-learning-wil-placement/270639.png","ImageObject",300,407,{"name":92,"@type":93},"Evangeline","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-15",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Who needs to complete the Decline to Vaccinate Form?","Question",{"text":113,"@type":114},"Students planning to undertake a placement who do not want to be vaccinated or who cannot provide evidence of their vaccination or immune status must complete the form.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What risks and implications are covered in the student declaration?",{"text":118,"@type":114},"The declaration explains increased risk of occupational exposure to infectious materials, potential healthcare setting transmission, and that not following vaccination recommendations may limit placement opportunities and extend course studies.",{"name":120,"@type":111,"acceptedAnswer":121},"What sections and signatures are required to complete the form?",{"text":122,"@type":114},"The form includes student details, a student declaration, a course coordinator signature section, and a student signature section acknowledging how personal information is collected and used.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},270639,1789456206,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":130,"read_time":39},13056703019662,"https://ap-avatar.wpscdn.com/avatar/be000253a8e92610077?_k=1778726343310543188","Faculty of Health  \nWork-Integrated Learning (WIL) -Placement  \nDecline to Vaccinate Form  \nFor use in accordance with CDU immunisation compliance requirements for students declining to be vaccinated  \nand/or provide evidence of their vaccination or immune status.  \nI have reviewed the Australian Government Immunisation Handbook:  Vaccines for People at Occupational Risk, which recommends vaccines for people who are at an increased risk of occupationally acquired vaccine-preventable diseases. The Faculty of Health offers many courses where students are required to participate in placements. Due to the professions and type of work students may undertake while on placement, they maybe at an increased risk of being exposed to biologically infectious material. The faculty, therefore, has a responsibility to ensure all students meet these vaccine requirements before commencing their placements. These requirements may also be imposed by the host organisation.  \nThe faculty recommends that all students be vaccinated (or provide evidence of their vaccination or immune status) before undertaking their placements due to the increased risk of being exposed to infectious material/diseases, and in some cases, the increased risk of exposing others to potential infections. Students planning on undertaking a placement who do not want to be vaccinated or provide evidence of their vaccination or immune status must complete the Decline to Vaccinate Form.  \nAdditionally, students declining to be vaccinated or immunised may limit their placement opportunities and/or their ability to complete their course requirements. Students are therefore advised to consult with their course coordinator to discuss any impact this may have on completing their course. May limit and consequently pose a risk of extending my course length if an appropriate placement cannot be sourced.  \n\n| SECTION ONE: Student Details |  |\n| --- | --- |\n| Student Name: |  |\n| Date of Birth: | Student ID: |\n| University Email: | Mobile: |\n| Course Name: | Course Code: |\n\n\n| SECTION TWO: Student Declaration |\n| --- |\n| I, (please print full name)   have read the Charles Darwin University (CDU) Faculty of Health Decline to Vaccinate information and understand the implications for me as a student in my course. I have carefully considered this information and understand it may impact my ability to complete my degree. |\n\n\n| I do not wish to become vaccinated or provide evidence of my immune status for the following compliance requirements: |  |  |\n| --- | --- | --- |\n| I understand that due to the type of work I may be required to undertake on my placement, I may be at an increased risk of being exposed to biologically infectious material and that I am required to receive certain vaccinations in accordance with mandatory vaccinations prescribed by the Faculty of Health or imposed by the Host Organisation. | 􀂅 Yes | 􀂅 No |\n| I understand that by declining to participate in vaccinations or providing evidence of vaccination or immune status, I am increasing my risk of occupational exposure to blood and/or other potentially infectious materials that could result in acquiring vaccine-preventable disease. | 􀂅 Yes | 􀂅 No |\n| I understand that I am at risk of exposure to and/or at risk of transmitting disease within the healthcare setting during my placement. | 􀂅 Yes | 􀂅 No |\n| I have sought and received advice from the appropriate medical practitioner about protecting myself and patients/clients. | 􀂅 Yes | 􀂅 No |\n| I understand that by not following the FoH recommendations regarding vaccinations, my placement opportunities may be limited and risk extending my course studies in trying to find an appropriate placement. | 􀂅 Yes | 􀂅 No |\n| I understand that this could impact my ability to complete my studies, and I have consulted with my course coordinator regarding this matter. | 􀂅 Yes | 􀂅 No |\n\n\n| SECTION THREE: Course Coordinator Signature |\n| --- |\n| I have advised the student to consult their me","cbCaikzzX6XVninV","https://ap.wps.com/l/cbCaikzzX6XVninV","pdf",221840,"English","# Student Details\n## Section One: Student Details\n## Section Two: Student Declaration\n## Section Three: Course Coordinator Signature\n## Section Four: Student Signature","[{\"question\":\"Who needs to complete the Decline to Vaccinate Form?\",\"answer\":\"Students planning to undertake a placement who do not want to be vaccinated or who cannot provide evidence of their vaccination or immune status must complete the form.\"},{\"question\":\"What risks and implications are covered in the student declaration?\",\"answer\":\"The declaration explains increased risk of occupational exposure to infectious materials, potential healthcare setting transmission, and that not following vaccination recommendations may limit placement opportunities and extend course studies.\"},{\"question\":\"What sections and signatures are required to complete the form?\",\"answer\":\"The form includes student details, a student declaration, a course coordinator signature section, and a student signature section acknowledging how personal information is collected and used.\"}]","Decline to Vaccinate Form - Faculty of Health Work-Integrated Learning (WIL) Placement | PDF"]