NSW Health Undertaking Declaration Form Guidelines
This form is essential for applicants seeking roles within NSW Health, ensuring they've completed necessary assessments. It outlines the compliance needed for vaccination against specified infectious diseases. Newly recruited staff, existing personnel, and students must understand its requirements before placements.
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How do I fill this out?
To fill out this form, begin by downloading the PDF. Carefully review all sections to ensure accuracy before selecting the applicable options. Complete each part of the declaration to ensure compliance with NSW Health policies.

How to fill out the NSW Health Undertaking Declaration Form Guidelines?
1
Download the undertaking/declaration form.
2
Read the form thoroughly and understand the requirements.
3
Tick options in the 'Undertaking/Declaration Form' that apply to you.
4
Fill out all sections of the 'Declaration' in detail.
5
Submit the completed form as part of your application/enrollment.
Who needs the NSW Health Undertaking Declaration Form Guidelines?
1
New recruits applying for a Category A position must complete this form.
2
Existing NSW Health staff undergoing re-assessment against the policy need this documentation.
3
Students seeking clinical placements in NSW Health facilities are required to submit this form.
4
Volunteers providing services at NSW Health locations must complete this undertaking.
5
Contractors and agency staff involved with NSW Health need to adhere to these requirements.
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What are the instructions for submitting this form?
To submit the completed NSW Health Declaration Form, ensure it is signed appropriately. Email it to the designated application address provided by your recruitment agency or education provider. Alternatively, you can fax it to the contact number specified in your instructions, or physically deliver it to the respective health facility.
What are the important dates for this form in 2024 and 2025?
It is essential to keep track of your deadlines for submission for the NSW Health Declaration Form in relation to specific placements. Important dates to consider include application deadlines for roles in health setting and clinical placements throughout 2024. Ensure that all documentation is submitted prior to these deadlines to avoid any delays.

What is the purpose of this form?
The purpose of the NSW Health Undertaking Declaration Form is to ensure that applicants are fully aware of and compliant with the health policies set forth by NSW Health. It serves as a necessary measure to assess the health risk management related to specified infectious diseases. By completing this form, individuals express their commitment to meet the required health assessments and vaccinations mandated for their role.

Tell me about this form and its components and fields line-by-line.

- 1. Date of Birth: The applicant's date of birth.
- 2. Worker/Student ID: An identifier provided by NSW Health or education provider.
- 3. Email: The email address for communication purposes.
- 4. Contact Number: A phone number where the applicant can be reached.
- 5. NSW Health Agency/Education Provider: The agency or educational institution associated with the applicant.
- 6. Signature: Signature confirming the accuracy of the provided information.
- 7. Date: The date when the form was signed by the applicant.
- 8. Parent/Guardian Name: For applicants under 18, the name of a parent or guardian.
- 9. Parent/Guardian Signature: The signature of the parent or guardian when applicable.
- 10. Date: The date when the parent/guardian signed the form.
What happens if I fail to submit this form?
Failing to submit the NSW Health Declaration Form can lead to significant delays in starting your role in the health sector. This may jeopardize your placement opportunities or job offer. It is crucial to adhere to submission timelines to ensure uninterrupted processing of your application.
- Placement Delays: Not submitting the form can result in a postponement of your clinical placements.
- Employment Risks: Your job offer might be rescinded if the necessary documentation is not submitted.
- Non-compliance Issues: Failure to comply with required forms could lead to disciplinary action.
How do I know when to use this form?

- 1. Applying for Category A Roles: Essential for all new recruits applying to roles that require health assessments.
- 2. Clinical Placement Registration: Students must submit this form to engage in clinical training arrangements.
- 3. Volunteer Participation: Volunteers providing services within NSW Health need to fulfill this obligation.
Frequently Asked Questions
Who needs to complete the NSW Health Declaration Form?
All new recruits, existing staff needing reassessment, students, volunteers, and contractors providing services must complete this form.
How can I edit the PDF form?
You can easily access the PDF editor on PrintFriendly, where you can modify text and fields with user-friendly tools.
What should I do if I have questions about filling out the form?
You can refer to the instructions provided on PrintFriendly or contact the relevant health facility for assistance.
How do I submit the completed Declaration Form?
Ensure you return the completed form to the designated health facility alongside your application or before your clinical placement.
Can I save the filled form on PrintFriendly?
You can edit and download your completed form conveniently on PrintFriendly.
Is there a deadline for submitting this form?
It's essential to submit your forms before commencing your clinical placement or employment.
What happens if I don't submit this form?
Failure to submit may result in delays in your placement or employment opportunities within NSW Health.
Can students' guardians sign the form?
Yes, if the student is under 18, a parent or guardian must sign the document.
What is the purpose of this form?
The form ensures compliance with health policies regarding vaccination and assessment requirements for specific roles.
How do I contact support if needed?
Contact the administrative or HR office of your respective health facility for inquiries.
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