This is a listing of all occupational health forms available from EHS. These forms should be used in conjunction with their corresponding plan or guide as applicable.
Please review the Hearing Conservation Plan for more information on how to complete this form. Contact EHS with any questions or concerns about hearing conservation.
Indoor Air Quality (IAQ)
Please visit the IAQ services page for more information on when and how to complete these forms. Contact EHS with any questions or concerns about IAQ.
- IAQ Investigation Request Form (PDF)
- IAQ Symptoms Log (PDF)
- Supervisor Request for Air Monitoring Evaluation (PDF)
Please review the Medical Surveillance Plan for more information on how to complete these forms. Contact EHS with any questions or concerns about medical surveillance.
- Medical Clearance Form (PDF)
- Medical Records Release and Authorization Form (PDF)
- Release of Immunization Records Form (PDF)
Employees determined to be exposed to harmful air contaminants are subject to the OSHA Respiratory Protection Standard (29 CFT 1910.134) and will be enrolled in Mason’s Respiratory Protection Program Plan. Prior to use, identified employees must be both medically evaluated (to determine their fitness to wear the respirator for the anticipated job/workplace conditions) and fit tested. Contact EHS for medical authorization or with questions/concerns about respiratory protection.