YesNo, if YES, were you exposed to biological or chemical agents (either in training or combat)?
2 answer the questions to the best of your knowledge. .
Race, whiteBlackHispanicAsianOther, date of Birth, age, have jouer au blackjack en ligne gratuit sans telecharger you ever worked on a hazmat team?
Social Security Number, sex, maleFemale, height, weight (lbs).Have you ever had any of the following conditions?YesNo, please check any of the following vision conditions that apply to you: Wear GlassesWear ContactsColor BlindOther eye or vision problems youve been told aboutLoss of vision in either eye?This can usually be done during your respirator training session.Those conditions not checked, do not apply to you.Thank you for your cooperation and patience.If you would like to talk to the reviewing health care professional, you may contact Integrity Safety Services to set up a meeting in person or by phone: All fields must be completed.Surveillance exam data is not considered clinically diagnostic.Best time to reach you: Email and phone number to send results/invoice.Please machine a poker gratuit en ligne quebec explain "When" for any of the above: Have you ever had any of the following cardio related conditions?Breathing or lung problemsHeart troubleBlood PressureSeizures Please note any other things that you take medications for.
Heart AttackStrokeAnginaHeart FailureSwollen legs or feetIrregular heart beat/arrhythmiaHigh blood pressureFrequent Chest PainChest pain or tightness during physical activityAny other symptoms that you think might martingale casino en ligne arnaque be related to heart or circulation problemsHeart missing or skips beats (last 2 years)Heartburn or indigestion not related to eatingChest pain.I understand that this information is to be used only by my employer for required health safety compliance programs.5 the conditions, circumstances, and limitations of your individual respirator usage status, can be explained to you by your safety supervisor. .I understand the screening results are for surveillance purposes only, and not to be considered clinically diagnostic.Employee Respirator Usage Assignment Sheet.To the employee: 1 your employer must allow you to answer this questionnaire during normal working hours, or at a time and place that is convenient to you. .
Have you ever had any of the following problems associated with respirator usage?: Eye IrritationSkin allergies or rashAnxietyOther, please check all that apply to you.