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INOP FORM

Occupational Medicine Logo

Job-Related Health Risk Checklist for Individuals Not On Positions (INOP)

  1. The department must complete this form and submit it before they request a post-employment health assessment (PPHA) at the UF Occupational Medicine Clinic (The Clinic).
  2. For health assessments that require an appointment at the Clinic, the department must call the Clinic directly at (352) 294-5700.
  3. For health assessments that do not require an appointment at the Clinic, the individual forwards the required form(s) to the Clinic at OccMedClinic-RiskAssessment@ahc.ufl.edu. Please refer to the Policies and Procedures document on the UF EH&S Health Assessments page.
  4. Department HR representatives may check the health assessment status in myUFL Workforce Monitoring.
    Employees may check the health assessment status in myUFL My Self Service.

Candidate Information

Candidate Name(Required)
Phone
Each job duty on this list triggers the need for the required health assessment below. Please check all job duties that apply.(Required)
Click the checkbox to indicate the job requirements are verified by the supervisor.(Required)
Phone Number(Required)
Email(Required)