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Pre-Employment Physical Assessment
Welcome to HCGH! We are looking forward to meeting you. Now that you have made your appointment for your pre-employment physical we need you to complete a few forms. Each form indicates where you are to stop. After you have printed and completed the forms, please sign them and bring them with you to your scheduled appointment.
- Registration for Occupational Health Services
- Immunization and Screening Record
- Preplacement Medical Physical Assessment (for completion by candidates only)
- TB Screening Form
- Health Information Release Authorization
- Respiratory Fit and Training Verification
- Respiratory Protection Questionnaire
- Hepatitis B Vaccine Packet
- TDAP (Tetanus, Diphtheria, and Pertussis) Vaccine Packet
- Drug Test Consent Form
- Essential Job Functions
Additionally, we need you to retrieve a few health records from your primary care physician or from your current employer/school. The following information is needed for your occupational health record:
- Hepatitis B vaccine series (3 dates) and;
- Hepatitis B titer results;
- Measles, Mumps, Rubella (MMR) vaccine (2 dates) or; MMR titer results;
- Varicella vaccine (2 dates) or; Varicella titer results;
- Most recent Tetanus booster date, either Td or Tdap vaccine;
- Current (less than 1 year old) negative Tuberculosis Screening (PPD) or; historical positive PPD results and; chest x-ray report that is less than one year old.
All health records are kept confidential in accordance with HIPAA regulations. Only Occupational Healthcare providers will review the information. It is our goal to keep you as healthy as possible as a Howard County General employee.
Your pre-employment physical is a clothes-on physical that includes an assessment of all major body systems, basic ergonomic assessment, immunization, safety and drug screening. You should plan on at least an hour for your appointment. Occupational Health is located in the Medical Arts Building, Suite 104 (#3 on campus map).
If you have any questions, please contact us at 410-740-7838 (M-F, 7:30am-4:00pm). Please bring your completed documents with you along with a photo identification of yourself to your scheduled appointment. Please arrive a few minutes early so we may review your information prior to your pre-employment physical. Thank you!
The Occupational Health Team