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MEDICAL SURVEILLANCE ASSESSMENT UNL Respiratory Protection Program Revised 3/11 (For assistance, please contact EHS at (402) 4724925, or visit our website at http://ehs.unl.edu/) Employees Name/ID

How to fill out medical surveillance assessment

How to fill out a medical surveillance assessment:

1. Start by carefully reading the instructions and understanding the purpose of the assessment.
2. Gather all the necessary information and documents such as medical history records, previous medical assessments, and relevant test results.
3. Begin by providing personal details such as your name, date of birth, and contact information.
4. Answer the questions related to your current health status, including any ongoing medical conditions or medications you are taking.
5. Provide information about your occupational history, including job titles, responsibilities, and the duration of employment in each job.
6. Answer questions regarding potential exposure to hazardous substances or risky environments during your work.
7. Fill out any additional sections or questionnaires specific to your occupation, such as respiratory health questionnaires for individuals working in dusty or polluted environments.
8. If required, visit a medical professional or occupational health specialist for a physical examination, and ensure they fill out the relevant sections of the assessment form.
9. Review all the information provided and make sure it is accurate and complete before submitting the assessment.
10. Once completed, submit the assessment to the appropriate authority or your employer, as instructed.

Who needs a medical surveillance assessment?

1. Individuals working in high-risk occupations or industries where exposure to hazardous substances, noise, or other occupational health risks is prevalent.
2. Workers who handle or come into contact with potentially harmful substances, such as chemicals, asbestos, or radiation.
3. Employees working in environments with physical stressors, such as heavy lifting or repetitive movements, which may impact their physical health.
4. Individuals employed in industries where there is a high likelihood of work-related injuries, such as construction or manufacturing sectors.
5. Individuals with pre-existing medical conditions that may be exacerbated by their work environment.
6. New employees starting a job in a high-risk occupation or industry, as a part of the overall onboarding process.
7. Existing employees who are exposed to new occupational health risks due to changes in their job roles or work environment.

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What is medical surveillance assessment?

Medical surveillance assessment is a process used to monitor the health status of individuals who may have been exposed to health hazards in the workplace.

Who is required to file medical surveillance assessment?

Employers are typically required to file medical surveillance assessments for their employees who work in potentially hazardous environments.

How to fill out medical surveillance assessment?

Medical surveillance assessments are typically filled out by medical professionals who have access to the necessary health information of the individuals being assessed.

What is the purpose of medical surveillance assessment?

The purpose of medical surveillance assessment is to ensure the early detection of any health issues that may be related to workplace exposures, and to take steps to prevent further harm to individuals.

What information must be reported on medical surveillance assessment?

Information reported on a medical surveillance assessment may include health history, exposure levels, and any health changes noted during the monitoring process.