Site Approval Request

HSPA defines a traditional hands-on experience clinical site as a hospital or an ambulatory surgery center. Occasionally, applicants for certification request to obtain their hands-on experience at a non-traditional site such as a dental or optical facility, a clinic procedure area, or a veterinary practice.

All requests for the use of a non-traditional site must be approved by HSPA before time is scheduled at the site.

The process is as follows:

Before beginning the hands-on experience, the applicant should submit the form below.
The application will be reviewed to determine if the site has the capability of providing all the required hands-on experiences.
The applicant will be notified of the approval status (accept/reject).

Incomplete applications will not be processed.

APPLICATION FORM

Select the credential you wish to obtain*

Today's Date*

APPLICANT INFORMATION

First Name*

Last Name*

Applicant's Street Address*

Applicant's City*

Applicant's State*

Applicant's Zip Code*

Applicant's Country (if outside the US)

Applicant's Email*

Applicant's Phone*

FACILITY INFORMATION

Please provide the following information about your facility:

Name of Facility*

Facility Street Address*

Facility City*

Facility State*

Facility Zip Code*

Facility Country (if outside the US)

Facility Website*

Facility Contact (First and Last Name)*

Facility Contact's Email[*Must be a business email address]

Facility Contact's Phone[*Must be a business phone number]

How large is the facility?*SmallMediumLarge

Average number of cases per day*

Number of procedure rooms*

Number of sterilizers*

PLEASE LIST THE INFORMATION BELOW

Please provide the following information about your facility:

List the types of surgical procedures performed at this facility*

List the methods of Sterilization used*

List the mechanical cleaning equipment available*

List the types of sterile packaging materials available*

HANDS-ON EXPERIENCE CHECKLIST

Please address how the facility can provide the following experiences:

Cleaning and assembling patient care equipment*

General cleaning of instruments, utensils, and specialty items and the
operation of mechanical washers*

Packaging using pouches, flat wraps, and rigid containers*

Instrument and procedure tray preparation (assembly/layout, inspection, and
identification)*

Sterilization (high temperature and low temperature sterilization processes,
use of sterilization quality assurance systems, record keeping, and sterility maintenance)*

Clean and sterile storage (rotating supplies, inventorying and restocking
carts/shelves, outdates, and cleaning storage shelves)*

Quality assurance processes, blood borne pathogen protocols, soiled
equipment pick-up, standards, regulations, policies and procedures*

This commitment to advancing Sterile Processing (SP) knowledge, skill sets and professionalism is why over 40,000 members and certification holders rely on HSPA to keep them sharp, focused and abreast of the very latest standards, best practices and technological advancements impacting the SP profession.