Submitting a Health Questionnaire Form
After completing a Risk Assessment, you will be directed to fill out the Health Questionnaire, which will be routed to a Medical Professional for review. You will receive a notification once the Medical Professional approves or requires changes to your Health Questionnaire.
- Confidentiality: Only you and the Medical Professional will have access to the Health Questionnaire. Your PI will not see this form.
- One-Time Completion: You only need to complete the Health Questionnaire once, and it can be reused for multiple Risk Assessments.
- Time Limit: The form has a 30-minute completion window, so be sure to have all relevant medical information, especially vaccination history, on hand.
Important Note: When completing the Health Questionnaire, ensure you have your vaccination records available. The Health Questionnaire does not auto-fill previous vaccinations or tests conducted by Occupational Health. If your vaccine history is incomplete on the form, the Medical Professional may recommend additional services before granting clearance.
You can obtain a Digital Vaccine Record (DVR) from the California Immunization Registry (CAIR). If you cannot find this record, it may lead to an unnecessary appointment or delay in your clearance.
Fill out the questionnaire as completely as possible. If you’re uncertain of vaccination dates, note that selecting "I don’t know" may result in a recommendation to update vaccinations before clearance.
What the Health Questionnaire Covers
The Health Questionnaire provides the Medical Professional with a summary of your medical history, including:
- Vaccination records
- General health history
- Exposure risks
- Biological hazards
- Allergies
- Prescription medications
- Recent health status changes
Completing the Health Questionnaire
- Accessing the Questionnaire: After agreeing to the Risk Assessment, you will be automatically directed to the Health Questionnaire. If you prefer to complete it later, you can access it at any time from the "Pending Actions" section on your home page.
- Reviewing or Updating: If a Health Questionnaire is already on file, you can review it and confirm if no updates are needed. If there have been changes in your health, click "Modify" at the bottom of the page to make updates.
- Finalizing: Once you have completed the Health Questionnaire, click "Save Health Questionnaire" to submit it.
Important: Please fill out the Health Questionnaire thoroughly and accurately to help prevent delays.
Once submitted, a Medical Reviewer will review both your Risk Assessment and Health Questionnaire and conduct a Medical Assessment if needed.
PartiCipant Submitting the Health Questionnaire Form