Annual Health Assessment Program
The UM-Flint Annual Health Assessment is administered on the Flint campus by the Environment, Health and Safety Department (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 assure this is so 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
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- 2013 Employee Health Assessment Request Form (PDF)
- Physical Qualification Form for Permitted Equipment Operators 2012 (PDF)
Genesys Occupational Clinic Annual Health Assessment Forms
GOHN Work & Medical History Form (PDF-2 pages)
GOHN Pre-Placement Medical History (PDF-2 pages)
GOHN Respiratory Protection Questioniare Part A&B (PDF-7 pages)
- GOHN Audiometric Hearing Questionnaire (PDF)