OccHealth ACP Forms
Professor in a Research Lab Students in a Research Lab Professor working in a Research Lab Students and Professor working in a Research Lab

OccHealth ACP Forms

To view a form or document, click on its name; it will open in a separate window.

Form/Document Name Description Who Completes It
Risk Assessment Work Evaluation Questionnaire for Employee/Affiliate (Participant) with Research Animal Exposure (Form A) Form to determine amount of exposure to animals (in the Animal Care Facility Persons (principal investigators and co-investigators; veterinarians; IACUC members; student assistants; student research assistants; university staff) who come in contact with research animals
Medical History Questionnaire for Employees/Affiliates with Research Animal Exposure (Form B) Form requesting medical information Persons (principal investigators and co-investigators; veterinarians; IACUC members; student assistants; student research assistants; university staff) who come in contact with research animals
Employee's First Report of Injury Form to report an animal care-related injury Any person who, in the course of animal care, becomes injured
Supervisor's Report of Incident, Injury or Illness Form to report an animal care-related injury The supervisor of any person who, in the care course of animal care, becomes injured
Employee's Election Regarding Utilization of Sick and Annual Leave for General Employees Form for injured or ill employees to designate the type of leave to be used An employee who has, in the course of animal care, has become injured or ill
OccHealth ACP Enrollment Form for enrolling in or opting out of, enrollment in the Occupational Health Animal Care Program Persons (principal investigators and co-investigators; veterinarians; IACUC members; student assistants; student research assistants; university staff) who come in contact with research animals