Employee Health Services Forms

Information Sheet

Non County – For use by non-County workforce members to obtain employment within Health Services.

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.

EHS Forms

• O-NC – Respirator Medical Evaluation Questionnaire – Questionnaire for fit test respirator greater than a N95 (such as a full-face respirator)

EHS Policies

Health Screening – NonCounty WFM Policy No. 705.001

Frequently Asked Questions

• FAQ

Health Clearance Requirements

• EHS Requirements