Forms and Instructions
Respirator Medical Evaluation Research Occupational Health Program Documents BSL-3 Documents
Respirator Medical Evaluation Please complete this survey before your Respirator Fit Testing. The purpose of this form is to obtain information about your personal health and work exposures. The Occupational Health Professional (OHP) will use this information to make an accurate assessment of your ability to safely wear a respirator. http://www.bhs.umn.edu/occhealth/Respirator_Med_Eval.pdf
Animal Exposure Questionnaire ROHP Animal Exposure Questionnaire
This questionnaire is required of all persons enrolled in the Research Occupational Health Program. Fax cover sheet for Animal Exposure Questionnaire
Please use this cover sheet to deliver your completed Animal Exposure Questionnaire to the Occupational Health Clinic at Boynton Health Service via fax. Immunizations Authorization for the Release of Health Information
Please use this form to authorize your health care provider to release your immunization history to the Occupational Health Clinic at BHS. If you choose to decline the rabies vaccine and/or toxoplasmosis titre, please download and complete the appropriate forms and return them to the Occupational Health Clinic at BHS. CDC Rabies Information Sheet and Declination Form for Rabies Vaccination Toxoplasmosis Information Sheet and Declination Form for Toxoplasmosis Titre If you have any questions about this process, you may contact Occupational Health by email at OHBHS@umn.edu or by phone at 612-626-9423.
BSL-3 Medical Questionnaire The purpose of this form is to obtain information about your personal health and work exposures. This information will be used by the Occupational Health Professional (OHP) to make an accurate assessment of your ability to safely work with biological and chemical agents in the BSL-3 laboratory. The OHP will evaluate the information on this form and document for you and your supervisor any work restrictions or protective measures to be followed. If restrictions and/or protective measures are required, it is the University’s expectation that you will comply. BSL-3 Medical Questionnaire BSL-3 Plant Facility Questionnaire The purpose of this form is to obtain information about your personal health and work exposures to biological and chemical agents and personal health information to help the University to assess your ability to work in a BSL-3 laboratory. You will be asked to complete this questionnaire periodically to assess ongoing risks and fitness for duty. A health care professional at the Occupational Health Clinic at Boynton Health Service will evaluate the information on this form and document for you and your supervisor any work restrictions or protective measures to be followed. http://www.bhs.umn.edu/occhealth/BSL3_Plant_Questionnaire.pdf
|
