University Employee Occupational Health Clinic Forms
- Indoor Air Quality Policy
Evaluation of Illness Believed Related to Indoor Air Quality at Work
Refer to the policy section “Employees with Continuing IAQ Complaints” for the proper use of this form.
- Research Animal Handlers Questionnaire
Online form for laboratory workers that handle research animals.
- Request for Services
If you are not flagged in the medical surveillance program, please complete the Request for Services form and fax to EHS at 919-962-0227.
- Request for Travel Immunizations for University Business Form
University policy requires University employees traveling internationally on University-sponsored business to be seen at the UEOHC prior to their trip.
- UEOHC Authorization to Release Medical Information
Allow UEOHC to release your immunization or other medical records.
- Release of Medical Information to UEOHC
Give permission for UEOHC to access immunization or other medical records.
- Medical Evaluation Questionnaire
OSHA Respirator Medical Evaluation Questionnaire adopted from 29 CFR 1910.134, Appendix C, January 8, 1998
- Medical Evaluation for Respiratory Use
- Hepatitis B Declination Form