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California State University, Long Beach

Physical Planning and Facilities Management
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CSULB Home   PPFM Home   Environmental Health & Safety   Forms

Forms

Environmental / Occupational Health & Safety

  • Job Site Safety Analysis (PDF)
  • Sharps Injury Log (PDF)

Medical Monitoring Program

  • Bloodborne Pathogens - Post Exposure Declination Form (PDF)
  • Occupational Questionnaire for Personnel Assigned to Laboratory Animal Facilities (PDF)
  • Medical Examination Appointment Letter (PDF) (SRMIS 001) 
  • Authorization to Release Medical Information (PDF) (SRMIS 002)
  • Authorization to Release Previous Medical Information (PDF) (SRMIS 003)
  • Health Status Medical Report (PDF) (SRMIS 004) 
  • Employee Medical Examination Findings (PDF) (SRMIS 005) 
  • Provider Examination Requests (PDF) (SRMIS 006) 
  • Exit Examination Employee Declination (PDF) (SRMIS 007) 

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California State University Long Beach

1250 Bellflower Boulevard
Long Beach, California 90840
562.985.4111