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  • Pregnant Worker Declaration (.pdf) - Oregon Health & Science ... - Ohsu

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OREGON HEALTH & SCIENCE UNIVERSITY RADIATION SAFETY OFFICE PREGNANCY DECLARATION FORM I, (print name), voluntarily declare my pregnancy so the Radiation Safety Office can monitor any work related.

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It's unlawful for you to be treated unfairly at work because you're pregnant. To take parental leave, you must notify your employer in writing at least 10 weeks before your last work day.

The Declaration of Pregnancy is a voluntary process that includes a written notification of the pregnancy by a radioactive material user to EH&S. This process includes a counseling session with the Radiation Safety Officer (RSO).

If I declare my pregnancy in writing, what happens? If you choose to declare your pregnancy in writing, the licensee must take measures to limit the dose to your embryo/fetus to 0.5 rem (5 millisievert) during the entire pregnancy. This is one-tenth of the dose that an occupational worker may receive in a year.

Q: Can I tell my employer orally or via email that I am pregnant? A: No, the declaration must be in writing for legal documentation reasons. The declaration must include an estimated conception date. The declaration only needs to be sent to Radiation Safety.

Standards for Protection Against Radiation that the dose equivalent to the fetus due to occupational exposure of a declared pregnant worker be kept below 500 mrem (5 mSv) during the pregnancy.

A pregnancy verification form is a letter that is used to show proof of a positive pregnancy test confirming that a woman is indeed pregnant. The form details the date when the individual visited the clinic/hospital, the estimated date of delivery, and any additional notes or comments related to the test.

I am writing to request that I would be allowed to work from home due to my pregnancy. I recently visited my doctor and declared me to have a high-risk one. He also advised me to avoid any travel and strenuous activity. As such, I will be unable to commute or drive to the office for the remainder of my pregnancy.

(28) “Declared pregnant woman” means a woman has voluntarily informed the licensee or registrant, in writing, of her pregnancy and the estimated date of conception. The declaration remains in effect until the declared pregnant woman withdraws the declaration in writing or is no longer pregnant.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232