Employee Health Services Forms
Pre-placement or Pre-assignment Health Clearance Packet
- Non-County – Non-County- For use by contractor staff, affiliate students, volunteers and vendors who are not Health Services – county employees. In addition, to be used for other county employees working in Health Services facilities such as DPH, DMH, Sheriff and Coroner.
Annual Health Screening Packet
- Non-County – For use by non-County workforce members to obtain annual health screening clearance. Health screening clearance must be obtained each year on the same month of assignment date with Health Services.
- O-NC – Respirator Medical Evaluation Questionnaire – Questionnaire for fit test respirator greater than a N95 (such as a full-face respirator)
Frequently Asked Questions
Health Clearance Requirements