Nurse Aide Training Prohibition Waiver Requests, F-02927 (01/2022)

Due to the public health emergency and worsening staffing crisis as a result of the pandemic, the Wisconsin Department of Health Services (DHS) is temporarily allowing waiver approval for nurse aide training prohibitions to allow training in and not by the facility, which may not have been approved prior to the pandemic based on the criteria set forth in Wis. Admin. Code §§ DHS 129.04(3)(a-f). Once the public health emergency has been lifted, this allowance will no longer be considered and the criteria included in Wis. Admin. Code §§ DHS 129.04(3)(a-f) will be followed.

By submitting this survey, you are requesting a waiver of Wis. Admin. Code §§ DHS 129.04(3)(a-d,f) to allow nurse aide training in but not by a facility that is under nurse aide training prohibition. Wis. Admin. Code § DHS 129.04(3)(e) is a federal regulation that cannot be waived.

Waiver requests are approved with the following conditions:

Nurse aide training must be provided by a third party unrelated to the facility that is under nurse aide training prohibition. You must submit a signed document from the third party agreeing to provide the training or to use the facility as a clinical site.
Any additional events that result in new nurse aide training prohibitions would require you to complete the survey again to request a separate waiver.

1. Contact Information *This question is required.

Contact Person First Name

Contact Person Last Name

Facility Name

Street Address

City

State

Zip

Email Address

Phone Number

2. Attach a signed document from the third party agreeing to provide the training or use the facility as a clinical site. *This question is required.

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