University of Florida

Environmental Health & Safety

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Forms

The need for any of the following forms depends on the department’s identification of specific job duties covered by the University of Florida’s Occupational Medicine Program. This can be done both during the hire process and during a change of duties process.

For those individuals hired on a specific position, the job duties are identified by position number in myUFL’s position information on the UF Hr Position Data tab.
(Navigation: Organizational Development, Position Management, Maintain Positions/Budgets, Add/Update Position Info)

For those individuals hired with no position attached (OPS or volunteers), the job duties are identified outside of PeopleSoft on the form
Job-Related Health Risk Checklist for Individuals Not On Positions (see INOP Form below).

Health Assessment Matrix can be filtered for applicable job duties and display one-page worksheet.

UF Employee Preplacement Health Assessments:  Policies and Procedures lists job duties and health assessment components.

OCCMED Clinic requires submission of the Payment Authorization Form prior to scheduling appointment in order for services to be rendered.

JOB DUTY

FORMS

All job duties for positions assigned numbers    Acrobat Supervisor Checklist for determining need for health assessment   
All job duties for OPS and volunteers    Acrobat lNOP Form (Individuals Not On Positions)   
All job duties    Acrobat Candidate Waiver Request   Word Word    
All job duties for outside the Gainesville area    Acrobat Fax Cover Sheet (for Medical Record Transfer)   
All job duties except Animal Contact,
Contact with Human Blood, Noise and Patient Contact    Acrobat Physical Exam and Medical History   
Animal Contact    Acrobat Risk Assessment for Animal Contact

Acrobat Renewal Risk Assessment for Animal Contact  

Email Completed Risk Assessment Forms to:

OccMedClinic-RiskAssessment@ahc.ufl.edu

Asbestos Work    Acrobat Initial Medical Questionnaire

Acrobat Periodic Medical Questionnaire

Acrobat  Review for Respirator Use

Acrobat Initial & Annual Medical Questionnaire for Respirator Use

BioPath (Work with risk group 3 agents in a BSL3 laboratory)    Acrobat BioPath: Biohazard Medical Monitoring Authorization Form

Acrobat BioPath: Biohazard Medical Assessment Questionnaire

Contact with Human Blood or OPIM    Acrobat Training and Vaccination Form   
Law Enforcement    Acrobat Hepatitis A Vaccination Form   
Noise    Acrobat New Hire Questionnaire

Acrobat Medical Update Form

Patient Contact    Acrobat Preplacement Screening Patient Contact Form

Acrobat  Respirator Medical History Questionnaire

Acrobat TB Surveillance Form

Patient Contact for Residents    Acrobat Preplacement Screening Patient Contact Form

Acrobat  Respirator Medical History Questionnaire

Acrobat TB Surveillance Form

Pesticide Use    Acrobat  Medical History Questionnaire for Pesticide Use   
Respirator Use    Acrobat  Review for Respirator Use

Acrobat Initial & Annual Medical Questionnaire for Respirator Use

Scientific Research Diving    Acrobat Diver Medical Evaluation of Fitness   Word Word

Acrobat Diver Medical History   Word Word

[Use the Same forms for both Preplacement and Periodic Requirements]


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