First Schedule., The Nurses Rules

FoRM A. Under section 19 of the Nurses Ordinance, the Nurses' Board of Sierra Leone has requested that you complete the form attached below and return to me. ' If no reply is received within six months your name will be erased from the Register and any Certificate(s) and Badge held by you will be cancelled according to section 19 of the Nurses Ordinance. Reg·istrar. --------------- ---------------------------·------------- FORM B. To TliE REGISTRAR, MEDICAL DEPARTMENT, I hereby declare that I am in practice as a Registered Nurse at the following address : ························································································································ ··············································································· ······································· ································································································································································ for .............................................................. :................................................................................................................................. . (Please insert name of Doctor under whom practising). My number on the Register is ............................................................................................................................ .. My permanent address is ....................................................................................................................................... .. ......................................................................................................................................................................................................... Date ........................................................................ l9 ...... . FORM c. Under section 19 of the Nurses Ordinance the Nurses' Board of Sierra Leone has requested that you complete the form attached below and return to me. If no reply is received within six months the name of... ................................................. .. will be erased from the Auxiliary Roll. FORM D. To THE REGISTRAR, NuRsEs' BoARD OF SIERRA LEONE, I hereby declare that .............................................................................................................................. . is employed and supervised by (name of Supervisory Authority) as a (name position in which employed). Date .................................................................................... l9 ...... . for Supervisory Officer. FORM E. THE NuRSEs' BoARD FOR SIERRA LEONE, FREETOWN . ......................................................................... ........ 19 I hereby certify on behalf of the Nurses' Board for Sierra Leone, that ........................................................................................................................................................................................... .. Form of reply. r. 5. r. 5. r. 6 (1). r. 6 (2). r. 7 (1). r. 7 (2). of ................................................................................................................................................................................................. . Registration No ....................................................................................... . Date of Registration ............................................................................. . Qualifications ............................................................................................. was removed from the .............................................................................. Register on. .................................. . FORM F. THE NuRsEs' BoARD FOR SIERRA LEoNE, .............................................................................. 19 ..... . I hereby certify on behalf of the Nurses' Board of Sierra Leone that ........................................................................................................................................................................................... . of .................................................................................................................................................................................................. . Enrolment No ............................................................. Date of enrolment ..................................................... . was removed from the part of the Auxiliary Roll on ................ :........................................ :...... .. FoRM G. .................................................................................... 19...... I hereby certify on behalf of the Nurses' Board for Sierra Leone that ........................................................................................................................................................................................... .. of ...............................................................................................................................................................................;................. .. is not registered on any part of the Nurses' Register kept under the .Nurses Ordinance. FORM H. FREETOWN . .............................................................................. 19 ...... I hereby certify on behalf of the Nurses' Board for Sierra Leone that ........................................................................................................................................................................................ . of.. ......................................................................................................................................................................................... . is not enrolled on any part of the Auxiliary Roll kept under the Nurses Ordinance. No. of Date of Regis· Registra- Name tration tion No. of Date of Enrol- Enrolment Name ment FoRM I. PLACE OF BIRTH Town Address or District Qualifica- Remarks Village tions FORM J. PLACE OF BIRTH Town Name of Address or District Supervisory Village Authority Remarks FoRM K. THE NURSES' BOARD FOR SIERRA LEONE. Application for Registration as a Trained Nurse or for enrolment as a nursing assistant or attendant. 1. Name of Register or Auxiliary RolL ............................................................................................ . (See list at end of this schedule). 2. Surname.................................................................................................................................................................... . 3. Other names ........................................................................................................................................................... . 4. Date of birth ........................................................................................................................................................ . 5. Permanent private address ................................................................................................................. . 6. Address of place or places where applicant practises nursing or of Supervisory Authority ................................................................................................................................ . 7. Tribe or nationality ........................................................................................................................................ .. 8. Place of birth....................................................... .. ............... District. ................................................... .. 9. Institution at which training was given .................................................................................. .. (If more than one, give name in each case). 10. Date of Commencement and termination of training .............................................. .. (if there was any break in the training, the dates of tMs must be shown). 11. Nu~?er of years applicant has practised nursing since completion of trammg ....................................................................................................................................................................... . 12. Has applicant ever been convicted of felony or any criminal offence against the Laws of Sierra Leone?... ........................................................................................... .. 13. Certificate attached from Medical Practitioner or Nursing Sister in charge of Training Institution. Name .......................................................................................................................................................................... . S.L.-VoL. VII-17 r. 9. r. 23. r. 28 (1). 1130 Cap. 152] Nurses 14. Two original testimonials of character and work to be submitted, one of which must be from a Registered Medical Practitioner or from a Nursing Sister registered as " State Registered Nurse." The names and addresses of such persons are.: (1) ........................................................................................................................................................................ (2) ........................................................................................................................................................................ 15. Any other relevant information..................................................................................................... . 16. Applicant must undertake to keep the Board informed of any change of address or place of work, and once yearly in June, of intention to continue to practise Nursing in the following year ........................................................... . Signature of Applicant. Dated at .................................................................................... 19...... . CERTIFICATE OF TRAINING OF APPLICANT FOR REGISTRATION AS A NURSE OR ENROLMENT AS A NURSING ASSISTANT OR ATTENDANT. I hereby certify from my personal knowledge from the records of this :~!~~~~o~;~~t;;ai:.~.:::::·.::::::::::·.·.:::~.::::::·.:::::::::::::::::·.:::::·.::::·.:::::·.:::::::::::::::::::::::::::::::::::·.·.::::·.::::::.:::·.:·.::::N~~~~g between the following dates ............................................................ at ........................................................... . .................................................................................... and that to the best of my knowledge and belief the particulars given overleaf by the applicant are true and correct. I recommend himfher accordingly for registration/enrolment. Qualification. Dated at.......................................................................................... 19...... . PARTS OF THE REGISTER OF NURSES IN SIERRA LEONE. (a) Female Nurses trained in general nursing. (b) Male Nurses trained in general nursing. (c) Nurses trained as Health Visitors. (d) Nurses trained as Sister Tutors. PARTS OF THE AUXILIARY ROLL OF NURSING ASSISTANTS AND ATTENDANTS IN SIERRA LEONE. (a) Nursing Assistants trained in general nursing. (b) Mental Hospital Attendants trained in attending mental diseases. (c) Infectious Diseases Attendants trained in attending infectious diseases. NoTE.- Training in Midwifery or Maternity Attendance does not entitle any person to registration or enrolment in any part of Nurses' Register or Auxiliary Roll. FoRM L. I have to inform you that the fee for Registration as a "Qualified Registered Nurse " is two pounds two shillings. Will you please remit this together with two copies of your photograph, passport size 2 ins. long by 1£ ins. wide to the Secretary of the Nurses' Board. One photograph to be affixed to your Registration Certificate, and one to be retained by the Nurses' Board for identification. Secretary, Nurses' Board. PLEASE DETACH AND RETURN. To THE SEcRETARY, THE NuRsEs' BoARD FOR SIERRA LEoNE, MEDICAL DEPARTMENT, I herewith enclose cheque/postal order to the value of two pounds two shillings made payable to the Nurses' Board to cover the fee for Registration as a Qualified Nurse. I also enclose two passport size photographs as requested. Date ................................................................................... l9 ...... . PERMANENT ADDRESS TO WHICH RECEIPT AND CERTIFICATE ARE TO BE SENT (Please write narne and address in block letters). FORM M. State Registered Nurse This is to Certify that .......................................................................................... has passed the Final State Examination in General Nursing in Sierra Leone on the ....................... . day o£... ............................................ .19 ............ and has satisfied the Nurses' Board that she is competent to practise. General Nursing; and that she/he is entitled to use the designation "State Registered Nurse" in Sierra Leone for such time as her name remains on the Register maintained by the Nurses' Board for Sierra Leone. S.L.-VoL. Vll-17* r. 29 (2). Given at Freetown this ........................ day of... ...............-........................... .19 ...... on behalf FoRM N Qualified Registered Nurse. This is to Certify that ........................................................................ satisfi.ed the Nurses' Board for Sierra Leone on the ........................ day o£. ................................................................ .19 ..... . by.................................................................. that shefhe is competent to practise General Nursing, and that therefore, shefhe is entitled to use the designation of "Qualified Registered Nurse" in Sierra Leone for such time as herfhis name remains on the Register maintained by the Nurses' Board for Sierra Leone. Given at Freetown this ........................ day o£............................................... .19 ...... on behalf FoRM 0. State Registered Male Nurse, This is to Certify that ............................................................ satisfi.ed the Nurses' Board for Sierra Leone on the ........................ day o£.................................................................................... 19..... . by........................................................................ that he is competent to practise General Nursing, and that, therefore, he is entitled to use the designation of" State Registered Male Nurse " in Sierra Leone for such time as his name remains on the General Part of the Register for Male Nurses in General Nursing maintained by the Nurses' Board for Sierra Leone. Given at Freetown this ........................ day o£... ............................................ .19 ...... on behalf FoRM P Qualified Registered Male Nurse. This is to certify that ............................................................ satisfied the Nurses' Board for Sierra Leone on the ........................ day of............................................................................. .l9 ..... . by........................................................................ that he is competent to practise General Nursing, and that, therefore, he is entitled to use the designation of" Qualified Registered Male Nurse" in Sierra Leone for such time as his name remains on the General Part of the Register for Male Nurses in General Nursing maintained by the Nurses' Board for Sierra Leone. Given at Freetown this ........................ day of................................................ on behalf of the Nurses' Board. FORM Q. REGISTRATION FOR HEALTH VISITORS. State Registered Health Visitor. No ........... ~ ............ on the Register. This is to certify that ............................................................ satisfied the Nurses' Board for Sierra Leone on the ........................ day of.................................................................................... l9 ..... . by........................................................................ that she is competent to practise Health Visiting, and that, therefore, she is entitled to use the designation of " State Registered Health Visitor " in Sierra Leone for such time as her name remains on the Supplementary Part of the Register of Health Visitors maintained by the Nurses' Board for Sierra Leone. Given at Freetown this ........................ day of............................................... .l9 ...... on behalf FoRM R. REGISTRATION FOR HEALTH VISITORS. Qualified Registered Health Visitor. This is to certify that ............................................................ satisfied the Nurses' Board for Sierra J..eonP. on the ........................ day of. .........--............................................. ,........................ 19 .... .. by....................................................................... that she is competent to practise Health Visiting, and that, therefore she is entitled to use the designation of" Qualified Registered Health Visitor " in Sierra Leone for such time as her name remains on the Supplementary Part of the Register for Health Visitors maintained by the Nurses' Board for Sierra Leone. Given at Freetown this ........................ day o£. .................................................... .19...... on behalf of the Nurses' Board. FORMS. REGISTRATION FOR NURSE TUTOR. State Registered Nurse Tutor. This is to certify that ............................................................ satisfied the Nurses' Board for Sierra Leone on the ........................ day o£.. .................................................................................. 19..... . by........................................................................ that she is competent to practise and that, therefore, she is entitled to use the designation of " Registered Sister Tutor " in Sierra Leone for such time as her name remains on the Supplementary Part of the Register for Sister Tutors maintained by the Nurses' Board for Sierra Leone. Given at Freetown this ........................ day o£... ............................................ .19 ...... on behalf FoRM T. ENROLMENT FOR NURSING ASSISTANTS IN GENERAL NURSING. Certified Nursing Assistant. No ......................... on the Auxiliary Roll. This is to certify that ........................................................... whose photograph is attached above satisfied the Nurses' Board for Sierra Leone on the ........................ day o£... ............................................................ 19 ...... by .................................................................................... that hefshe is competent to practise General Nursing as a Nursing Assistant in the employment of, and under the supervision of a Supervisory Authority, but not otherwise, and that, therefore, he/she is entitled to use the designation of "Certified Nursing Assistant" in Sierra Leone for such time as hisfher name remains on the Auxiliary Roll maintained by the Nurses' Board for Sierra Leone. Nurses [Cap. 152 1135 --------------------------------------------------------------- Given at Freetown · this........................ day of......................................................l9...... on behalf of the Nurses' Board. FoRM U. ENROLMENT FOR MENTAL HOSPITAL ATTENDANTS. Certified Mental Hospital Attendant. No ......................... on Auxiliary Roll. This is to certify that............................................................ whose photograph is attached above satisfied the Nurses' Board for Sierra Leone on the .................. day of............................................................ l9 ...... by.................................................................................... that he/she is competent to practise General Nursing as a Mental Hospital Attendant in the employment of, and under the supervision of a Supervisory Authority, but not otherwise, and that, therefore, he/she is entitled to use the designation of " Certified Mental Hospital Attendant " in Sierra Leone for such time as his/her name remains on the Auxiliary Roll maintained by the Nurses' Board for Sierra Leone. Given at Freetown this........................ day of......................................................l9...... on behalf of the Nurses' Board. FORM v. ENROLMENT FOR INFECTIOUS DISEASES ATTENDANTS. Certified Infectious Diseases Attendant. No ......................... on Auxiliary Roll. This is to certify that ............................................................ whose photograph is attached above satisfied the Nurses' Board for Sierra Leone on the .................. day of...................................................... l9 ...... by.................................................................................... that he/she is competent to practise General Nursing as an Infectious Diseases Attendant in the employment of, and under the supervision of a Supervisory Authority, but not otherwise, and that, therefore, he/she is entitled to use the designation of " Certified Infectious Diseases Attendant " in Sierra Leone for such time as his/her name remains on the Auxiliary Roll maintained by the Nurses' Board for Sierra Leorie. Given at Freetown this ........................ day of................................................l9 ...... on behalf r. 44 (2). Cap. 152] To THE SECRETARY, THE NuRsEs' BoARD, Nurses FORM w. .. I beg to apply through the Medical Officer/Practitioner/Nursing Sister in charge of my training institution for registration as a Pupil Nurse/ Probationer Nurse. (Strike out words which do not apply). 1. N arne ........................................................................................................................................................................... (Block Letters Please). 2. Date of birth. ....................................................................................................................................................... . 3. Tribe .................................................................. Town or Village ................................................................. . 4. Place of birth .......................................................................................... District ........................................ .. 5. Educational standard attained ........................................................................................................... . (Certificate to be attached). 6 Nursing Training Institution (Name) ..................................................................................:.... . Full address ........................................................................................................................................................... . 7. Permanent home address .......................................................................................................................... . 8. Date training commenced...................................................................................................................... .. 9. I certify that I have never been convicted of felony or of any criminal offence against the Laws of Sierra Leone except (give particulars) 10. I undertake to sit the examination prescribed by the Nurses' Board. · 11. I undertake to keep the Nurses' Board informed of any change of address. Dated at ...................................................................... 19 .... . CERTIFICATE OF TRAINING IN NURSING TO BE COMPLETED BY MEDICAL PRACTITIONER-IN-CHARGE OR NURSING SISTER-IN- CHARGE. I hereby certify that (Name) .......................................................................................................... .. is a .................................................................. Nurse of... .................................................................................................. . (Nursing Institution). and that the particulars given by the applicant, are, to the best of my knowledge, correct. I recommend him/her for registration as NursefNurse Assistant/Nurse Attendant in training in.................................................................. Nursing. (Please strike out words which do not apply, and for parts of the Register pleasE see below)- PARTS OF THE REGISTER/AUXILIARY ROLL OF NURSES, NURSING ASSISTANTS AND ATTENDANTS IN SIERRA LEONE. (a) Female Nurses trained in General Nursing. (b) Male Nurses trained in General Nursing. (c) Nurses (Male and Female) trained in the Nursing of Mental Diseases. (d) Nurses (Male and Female) trained in the Nursing of Infectious Diseases. (e) Nurses trained as Health Visitors. (f) Nurses trained in the care of Sick Children. NoTE.-Applications must be accompanied by original certificate of education and 111ust be sent by registered post. FORM X. DETAILS REQUIRED IN INDEX OF PUPIL NURSES. No. in Date PLACE OF BIRTH. Index. entered in Name. Address. Training Remarks. in Index. Town or Village. District. FoRM Y. SIERRA LEONE NURSES' BOARD FORM OF APPLICATION FOR ENTRY TO EXAMINATION. NURSES' BOARD FOR SIERRA LEONE. QUALIFYING EXAMINATION. APPLICATION FOR ENTRY. I beg to submit application for entry to the above examination. Name ......................................................................................................................................................................................... . Age ............................................................................................................................................................................................... . Permanent address ........................................................................................................................................................ . Name and address of training Institution............................................................................................... . Date and commencement of training ........................................................................................................ . If any breaks in training please give duration of such........................................................... . Have you entered previously for this examination 1 If so give date .................................................................................................................................................................... . If re-entry state whether for whole examination or for referred subjects giving name of each: .....................................................; .....•... ~ ......................................................................................................................................... Name of Medical Officer or Nursing Sister who vouches for teaching r. 44. (3). r. 50 (a) (ii). r. 54 (b). I hereby certify that the above particulars are correct. Signature of Candidate. Date ............................................................................................... . CERTIFICATE OF TRAINING. l'o be completed by Medical Officer or Nursing Sister in charge of Institution where above candidate is in training. I hereby certify that .................................................................................................................................... has been a Pupil Nurse at ................................................................................................................................... . for a period of... .......................................................................................and that he/she is still in training and that hefshe has received practical teaching in the nursing of patients in the wards and that hefshe has attended lectures given in accordance with the syllabus approved by Nurses' Board for this examination having attended seventy-five per cent. of the lectures in each subject of the syllabus for the qualifying examination as specified in the 6th Schedule to the Nurses' Date .............................................................................. 19...... . Signature of Sponsor. Qualification. This certificate must be completed before form Y is returned to Registrar. FoRM Z. ........................................................................ 19...... To ........................................................................................................ . of ........................................................................................................ . Registration No ..................................................................... . Take notice that the charge (charges) against you, particulars of which are set forth below, hasfhave been brought to the notice of the Nurses' Board and that the Nurses' Board propose to investigate such charge(s) at a meeting to be held in the Headquarters of the Medical Department, Freetown, at ........................ a.m.fp.m. on ............................................................ the ............................................................... 19 ..... . to determine whether you should be suspended from practice of nursing, or be removed from the register. You may attend the above hearing if you wish, covering your own expenses. It is imperative that you should either send by registered post to the Secretary of the Board before the above date fixed for the hearing, or bring with you to the hearing your certificate(s) and badge. Particulars of charge(s)-