Questionnaires

Introduction of New Questionnaires

ROHP is introducing revised questionnaire forms to be completed by employees engaged in or supporting research activities at Boston University. The two revised questionnaire forms are the Initial Health and the Annual Health Status Questionnaires.  These questionnaire forms replace the Medical Surveillance Form, the Animal Exposure Surveillance Program Medical Evaluation Form, and the Med Surveillance For Lab Animal Exposed Annual Occupational Health Questionnaire.

In addition to consolidating the number of questionnaires used to perform medical surveillance for the research community, the purpose of the new questionnaires is to:

  • Enhance the quality and clarity of information provided to perform individual risk assessments as part of research medical surveillance
  • Extend its use to include non-researchers who provide support to or have access to areas where research is performed with animals, agents and hazardous materials

Initial Health Questionnaire

The purpose of the Initial Health Questionnaire (IHQ) is to establish a baseline medical history and perform a health risk assessment for each individual. The questionnaire should be completed before work in a research environment begins.

The IHQ must be completed by newly hired personnel, including contractors, students and volunteers, who will perform research, or, provide support to or have access to areas where research is performed with animals, agents and hazardous materials.

The IHQ replaces the Animal Exposure Surveillance Program Medical Evaluation Form and Medical Surveillance Form.

Annual Health Status Questionnaire

The purpose of the Annual Health Status Questionnaire (AHQ) is to perform a periodic health review for all personnel who have direct or indirect exposure to infectious agents, animals, animal tissues, and/or time spent in an animal care facility. The occupational health program requires periodic health reviews and updates for all personnel. The use of this form is required for the following groups:

  • Researchers and PI’s listed in animal protocols
  • LASC and LACF staff
  • IACUC members and staff
  • Employees not working directly with animals but requiring access to laboratories with animals (i.e., emergency response, public safety, facilities, etc.)

The AHQ should also be completed by all laboratory staff including the Principal Investigator for submission of an IBC application or if adding staff to approved IBC protocols

The AHQ replaces the Med Surv For Lab Animal Exposed Annual Occ Health Questionnaire.

OSHA Respirator Medical Evaluation Questionnaire

The Respiratory Medical Evaluation Questionnaire form was revised to conform more closely with OSHA information and disclosure requirements.

The purpose of the OSHA Respiratory Questionnaire is to determine medical fitness to use respiratory protection. A surgical mask is not considered respiratory protection. If informed that your job requires respiratory protection, please complete the OSHA Respirator Medical Evaluation Questionnaire.

After the respiratory questionnaire has been completed and reviewed by an ROHP medical provider, a medical clearance form will be provided to you as documentation which must be provided to EHS prior to fit testing.

Where to go for respiratory fit testing?

When medical clearance has been granted by ROHP, a respirator fit test must be performed by EHS before work that requires the use of a respirator can commence. Please click on this link http://www.bu.edu/ehs/services/fit-testing//EHS Respirator Fit Testing to complete a request for respirator fit test.  EHS will contact you to arrange a date/time for fit testing.  Boston University and Boston Medical Center (BMC) requires that all employees, medical staff and students, who wear a respirator are provided a respirator that fits properly and are trained in its use.