Get the free Annual Medical Surveillance Questionnaire

Annual Medical Surveillance Questionnaire Completion of this form is an annual requirement for all CU Denver/Anschutz employees who work with animals or hazardous materials. Access to the CU Anschutz

How to fill out annual medical surveillance questionnaire

How to fill out annual medical surveillance questionnaire

1. Gather personal information: Include your name, address, date of birth, and contact information.
2. Provide employment details: State your current job title, department, and duration of employment.
3. Answer health history questions: Report any past medical conditions, surgeries, or chronic illness.
4. Disclose medication usage: List any medications you are currently taking.
5. Indicate occupational exposure: Note any potential exposure to hazardous materials or environments.
6. Complete lifestyle questions: Address lifestyle factors including smoking, alcohol consumption, and exercise habits.
7. Review and sign: Ensure all information is accurate before signing the declaration at the end of the questionnaire.

Who needs annual medical surveillance questionnaire?

1. Employees working in high-risk occupations such as construction, chemical manufacturing, or healthcare.
2. Workers who handle hazardous materials or are exposed to toxic substances.
3. Individuals with pre-existing health conditions related to their job.
4. New employees, as part of their onboarding process to ensure workplace safety.
5. Employees returning from medical leave who may need assessment before rejoining work.

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What is annual medical surveillance questionnaire?

The annual medical surveillance questionnaire is a document used to collect health-related information from individuals to monitor their well-being and identify any potential health risks associated with their work environment.

Who is required to file annual medical surveillance questionnaire?

Employees who work in environments with potential health hazards, such as those in industries like construction, healthcare, or chemical handling, are often required to file the annual medical surveillance questionnaire.

How to fill out annual medical surveillance questionnaire?

To fill out the annual medical surveillance questionnaire, individuals should provide accurate and complete information about their medical history, exposure to workplace hazards, symptoms they may be experiencing, and any relevant lifestyle factors.

What is the purpose of annual medical surveillance questionnaire?

The purpose of the annual medical surveillance questionnaire is to assess the health of employees, detect any emerging health issues, and ensure that appropriate measures are in place to prevent occupational illnesses.

What information must be reported on annual medical surveillance questionnaire?

The annual medical surveillance questionnaire typically requires information on personal medical history, current health status, occupational exposure details, symptoms, and lifestyle factors that could impact health.