Annual Health Assessment
The UM-Flint Annual Health Assessment is administered on the Flint campus by the Office of Environment, Health and Safety (EHS). The purpose of the program is to prevent occupational illness and injury among employees by monitoring certain health indicators that give clues to potential exposures and injury risks. Our shared goal is to provide a workplace generally free from overt health hazards. EHS works closely with other university departments to ensure this through program development, training, workplace inspections and accident investigations.
EHS has written guidelines for this program that describe internal procedures. If you have any questions, please contact Lora Rometsch, the coordinator of this program at 766-6763 or firstname.lastname@example.org.
UM-Flint EHS Health Assessment Forms
Note: You must have Adobe Acrobat Reader in order to view these files.
Download Adobe Acrobat Reader
- 2016 Employee Health Assessment Request Form (PDF)
- Physical Qualification Form for Permitted Equipment Operators 2016 (PDF)
Genesys Occupational Clinic
Annual Health Assessment Forms
GOHN Pre-Placement Medical History (PDF-2 pages)
GOHN Work & Medical History Form (PDF-2 pages)
GOHN Respiratory Protection Questionnaire (PDF-5 pages)
GOHN Patient Information (PDF-2 pages)