This Employee Health Assessment is an essential aspect of your employment within our healthcare system. Please read thoroughly before beginning.
You will need to gather the following documentation and dates to complete the health form below.
All fields marked with * are required.
Please upload a copy of all past immunizations, including all those received as an infant or child and / or you may continue to sections below.
Seasonal flu vaccination is required for all employees during flu season.
Hepatitis B vaccinations are not a requirement, but recommended for anyone at risk for exposure to blood and/or blood products. A declination must be completed if applicable.
Two Varicella vaccinations OR a positive titer will be accepted.
Have you had any of these signs/symptoms in the last year? (All questions must be answered.)
I certify that all of the statements provided here are true and correct to the best of my knowledge.