Get the free Medical Surveillance Request Form - oseh umich
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This form is used for requesting medical surveillance examinations for employees at the University of Michigan, including various types of examinations related to occupational health and safety.
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How to fill out medical surveillance request form
How to fill out Medical Surveillance Request Form
01
Obtain the Medical Surveillance Request Form from the designated HR or safety department.
02
Fill in your personal information at the top of the form, including your name, job title, and department.
03
Specify the reasons for the medical surveillance request based on workplace exposures or health concerns.
04
Provide details of the specific hazardous materials or conditions you have been or will be exposed to.
05
Sign and date the form to certify that the information is accurate and complete.
06
Submit the completed form to your supervisor or the designated personnel for approval.
Who needs Medical Surveillance Request Form?
01
Employees who work with hazardous materials or are exposed to potentially harmful conditions.
02
Workers in roles that involve regular health monitoring as part of occupational health programs.
03
Individuals who are required by OSHA or other regulatory agencies to undergo medical surveillance due to specific job-related hazards.
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What is Medical Surveillance Request Form?
The Medical Surveillance Request Form is a document used to request medical monitoring and surveillance for individuals potentially exposed to hazardous materials or conditions in the workplace.
Who is required to file Medical Surveillance Request Form?
Employers are typically required to file a Medical Surveillance Request Form for employees who are at risk of exposure to hazardous substances or who work in environments that require monitoring for health effects.
How to fill out Medical Surveillance Request Form?
To fill out the Medical Surveillance Request Form, provide accurate employee information, detail the nature of exposure, list any symptoms, and include necessary medical history along with the request for surveillance.
What is the purpose of Medical Surveillance Request Form?
The purpose of the Medical Surveillance Request Form is to ensure that employees who may be at risk for health issues due to workplace exposures receive appropriate medical evaluation and monitoring to prevent long-term health effects.
What information must be reported on Medical Surveillance Request Form?
The information that must be reported includes the employee's name, identification details, job title, nature of exposure, duration of exposure, any reported symptoms, and medical history relevant to the exposure.
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