Employee Health Notification to UEHC

Was there a body fluid exposure?

If yes, complete the form below

If no, skip the following questions and proceded to filling out the First Report of injury form as directed.

 

COMPLETE FORM FOR BODY FLUID EXPOSURE ONLY!

In order to comply with OSHA regulations this form must be completed and submitted to the University Employee Health Clinic (UEHC).

Please enter the name of the employee:
  

   
Please enter employee Hospital Number:
  

   
Please enter employee's date of birth (mm-dd-yyyy):
  

   
Please enter the date seen for incident (mm-dd-yyyy):
  

   
Was there body fluid exposure? (yes or no):
  

To complete the First Report of Injury Form, sign in to the University of Iowa HR Self-Serve website (https://hris.uiowa.edu/portal/).

Page updated: June 16, 2008 3:33 PM