Annual Employee Health Assessment

Annual Employee Health Assessment - Have you had a positive...

Info icon This preview shows pages 1–2. Sign up to view the full content.

View Full Document Right Arrow Icon
Annual Employee Health Assessment Employee Name__________________________ Site________________ Date_________ Circle: Business Clinical In the past year 1 Have any medical conditions developed or changed that will interfere with the essential functions of your job? ________ No _________ Yes If you answered yes please explain ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ _____ 2 Have you developed any allergy to latex or other natural rubber products? _______ No ________ Yes If you answered yes please explain ___________________________________________ ___________________________________________ ______________________________ 3 Tuberculosis: Tuberculosis skin testing is required annually for all staff unless you have a history of a positive PPD or the disease.
Image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 2
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: Have you had a positive PPD in the past? ______ No ________ Yes Of you answered yes have you had any fever, weight loss, night sweats, cough (dry or productive), bloody sputum, or chest pain that lasted more than 5 days in the past year ____ No ________ Yes If you answered yes please explain any follow-up care you received ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________ Annual PPD Date Immunization Dose/route Site Exp date Lot # Nurse Results: _______ Negative ________ Positive Date read: _________ Read by: _________ I certify that the information on this form is complete and accurate to the best of my knowledge. Employee Signature ______________________ Date__________ Reviewed by_____________________________ Date __________...
View Full Document

  • Spring '08
  • Barlow
  • cough, positive PPD, Employee Health Assessment, Employee Name__________________________ Site________________, Tuberculosis skin testing

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern