OCCMED 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.

Please read instructions and fill out forms carefully! Failure to complete forms correctly may delay processing.

Save a completed copy of the form for your records before submission/e-mailing.

As a best practice for fillable .pdf files:

  1. “Save As” with appropriate name to your PC to download form
  2. Complete using Acrobat Reader and Save
  3. Click “submit” to open email
  4. Attach if necessary and Send

JOB DUTY

FORMS

All job duties for positions assigned numbers Supervisor Checklist for determining need for health assessment
All job duties for OPS and volunteers lNOP Form (Individuals Not On Positions)
All job duties Candidate Waiver Request Word
All job duties for outside the Gainesville area Cover Sheet (for Medical Record Transfer)

Physical Exam (outside the Gainesville area)

All job duties except Animal Contact,
Contact with Human Blood, Noise and Patient Contact
Physical Exam and Medical History
Animal Contact Do not make any changes to page 1 of Animal Contact form after supervisor signature is entered.

Risk Assessment for Animal Contact
Risk Assessment for Animal Contact – VetMed Only

Asbestos Work Medical Questionnaire

Review for Respirator Use
Initial & Annual Medical Questionnaire for Respirator Use

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

BioPath: Biohazard Medical Assessment Questionnaire

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

Medical Update Form

Patient Contact Post Offer Screening Patient Contact Form

Respirator Medical History Questionnaire
TB Surveillance Form

Patient Contact for Residents Post Offer Screening Patient Contact Form

TB Surveillance Form

Pesticide Use Medical History Questionnaire for Pesticide Use has been combined with the Respirator Medical Questionnaire
Respirator Use Review for Respirator Use

Initial & Annual Medical Questionnaire for Respirator Use
Initial & Annual Medical Questionnaire for Respirator Use for Vet Med only

Scientific Research Diving Diver Medical Evaluation of Fitness | Word

Diver Medical History

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