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