Get Binghamton University Annual Health Screening Questionnaire 2007-2025

Filling out the Binghamton University Annual Health Screening Questionnaire online is an important step for faculty, staff, and students involved in the Occupational Health and Safety Program for Laboratory Animal Resources. This guide provides a clear, step-by-step process to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the questionnaire online.

1. Click the ‘Get Form’ button to obtain the form and access it for editing.
2. Begin with Section 1: Personal Information. Fill in your last name, first name, and middle name as appropriate. Provide your home address, campus address, campus phone, personal email, and local or cell phone number. Include your birth date and indicate your sex. In case of an emergency, provide the name and relationship of a person to be notified, as well as their phone number. Also, include the name and phone number of your primary care physician. Lastly, fill in your university department information, the investigator's lab you are working in, and your anticipated completion date for your studies.
3. Proceed to Section 2: Risk Assessment. Indicate your employment status by checking the relevant box. List any animal species you are currently working with. Estimate the amount of time you plan to spend in the animal lab or doing field work by selecting the appropriate frequency option. If you are not handling animals but are working in an animal laboratory environment, please provide an explanation.
4. Move to Section 3: Medical History Screening. Check all applicable medical conditions you have been informed of in the past year. If you have asthma, answer the follow-up questions regarding its control and triggers. For allergies, indicate any new allergies and symptoms. Specify any heart disease, immune status changes, or treatments for acute or chronic illnesses. If you identify as female, state whether you are pregnant. List any recent immunizations, work restrictions, and new symptoms related to your work environment.
5. Finally, review all the information you have provided to ensure its accuracy. Once completed, you may sign and date the form, attesting to the correctness of your information. It is essential to understand that this information contributes to a confidential database intended to reduce exposure risks.
6. After ensuring all information is accurately filled out, save the changes to your document. You can download, print, or share the completed form as required. Make sure to return the form to Dr. Diane L. Paukett, D.O., as instructed, marked confidential.

Complete your Binghamton University Annual Health Screening Questionnaire online today to ensure a safe and healthy work environment.