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University Health Center
MyUHC Your Visit Patient Services Wellness & Advocacy Insurance & Billing About Us
MyUHC Your Visit
Hours and Location Appointments Emergency Patient Forms Patient Rights and Responsibilities Notice of Privacy Practices Drug Facilitated Sexual Assault (DFSA) Information
Patient Services
Medical Services Faculty Staff Assistance Program Occupational Health Psychiatry and Substance Use Services (PASS) Substance Use Intervention & Treatment (SUIT) Clinics
Wellness & Advocacy
CARE to Stop Violence Health Promotion & Wellness Services
Insurance & Billing
Mandatory Insurance and Waiver Billing and Costs Insurance and Billing Contacts Insurance Filing Mandatory Insurance FAQ
About Us
Meet Our Team Mission and Values Who Can Use Our Services Campus Communications Patient Feedback Student Involvement Contact Us
Hours and Location Appointments Emergency Patient Forms Patient Rights and Responsibilities Notice of Privacy Practices Drug Facilitated Sexual Assault (DFSA) Information
Medical Services Faculty Staff Assistance Program Occupational Health Psychiatry and Substance Use Services (PASS) Substance Use Intervention & Treatment (SUIT) Clinics
CARE to Stop Violence Health Promotion & Wellness Services
Mandatory Insurance and Waiver Billing and Costs Insurance and Billing Contacts Insurance Filing Mandatory Insurance FAQ
Meet Our Team Mission and Values Who Can Use Our Services Campus Communications Patient Feedback Student Involvement Contact Us

Occupational Health Forms

Home Occupational Health Forms

Pre-placement forms are required for various Occupational health surveillance programs on campus. Please make sure you complete your forms before arriving at your appointment. Click on the link below to complete the appropriate form for your program. If you are not completing your form through the MyUHC portal, you must complete and bring your form to your appointment.

Occupational Health Forms

Animal Handler

Please review the Notice of Privacy Practices before completing this form.  Printing is not required. 

 

Animal Handler Assessment Form

Initial
Asbestos

Click the button below to view or download

 

Initial
Asbestos
Questionnaire


Periodic
Asbestos

Click the button below to view or download

 

Periodic
Asbestos
Questionnaire


Respirator Evaluation

Please review the Notice of Privacy Practices before completing this form.  Printing is not required.

  

Respirator Questionnaire

Employment Physical

Vaccinia (Small Pox)

TDap

Click the button below to view or download

 

TDap Information & Waiver

Hepatitis B

Click the button below to view or download

 

Hepatitis B Vaccine Form
University Health Center
University Health Center, Building #140
health@umd.edu 1-301-314-8184