EHS Blank Form
Pre-placement or Pre-assignment Health Clearance Packets

     1.  Volunteer - For use by volunteers
     2.  Non-DHS - For use by other County employees working in our facilities such as DPH, DMH, Sheriffs, and           Coroner
     3.  PSA (Medical Staff)- Option 1- Health screening provided by your physician or licensed health care           professional
     4.  PSA (Medical Staff)- Option 2- Health screening provided by DHS Employee Health Services
     5.  Non-County - For use by contractor staff, students, vendors, and affiliate schools who are NOT County           employees
     6.  DHS-Sponsored Student - For use by health professions students who are registered in the County's
          sponsored health professional schools

     7.  DHS-Sponsored GME Program - For use by incoming Interns, Residents, and Fellows from Accreditation
          Council for Graduate Medical Education (ACGME) approved programs

Annual Health Screening Packet

     1.  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 DHS.

EHS Forms

     1.  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 - Non-County WFM Policy No: 705.001