If working with Year of Last human primates. Year of Last Year of Last Vaccination: Year of Last Vaccination: Vaccination: Hepatitis B Vaccination: If working with Year of Last primates. Year of Last Year of Last Vaccination: Year of Last Vaccination: Vaccination: Diphtheria Vaccination: If working with Year of Last primates. Year of Last Year of Last Chickenpox Vaccination: Year of Last Vaccination: Vaccination: (Varicella) Vaccination: If working with Year of Last primates. Year of Last Year of Last Measles, Vaccination: Year of Last Vaccination: Vaccination: Rubella (MMR) Vaccination: If working with Year of Last primates. Year of Last Year of Last Whooping Cough Vaccination: Year of Last Vaccination: Vaccination: (Pertussis) Vaccination: If working in an If working in an If working with emergency clinical setting, emergency clinical setting, TB test Year of Last Test: primates. respiratory ward, or with respiratory ward, or with Year of Last Test: known TB patients known TB patients (Mantoux) Year of Last Test: Year of Last Test: If working with Year of Last primates. Vaccination: Year of Last Poliomyelitis Vaccination: If working with Year of Last primates. Year of Last Year of Last Vaccination: Year of Last Year of Last Vaccination: Vaccination: Vaccination: Tetanus Vaccination: Only if working with live bacterium or toxin Year of Last Year of Last Vaccination: Vaccination: Rabies/Lyssavirus Year of Last Year of Last Vaccination: Vaccination: Q-Fever Employee declaration Section D – employee agreement
human Hepatitis B Year of Last Vaccination: If working with primates. Year of Last Vaccination: Year of Last Vaccination: Year of Last Vaccination: Diphtheria Year of Last Vaccination: If working with primates. Year of Last Vaccination: Year of Last Vaccination: Year of Last Vaccination: Chickenpox (Varicella) Year of Last Vaccination: If working with primates. Year of Last Vaccination: Year of Last Vaccination: Year of Last Vaccination: Measles, Rubella (MMR) Year of Last Vaccination: If working with primates. Year of Last Vaccination: Year of Last Vaccination: Year of Last Vaccination: Whooping Cough (Pertussis) Year of Last Vaccination: If working with primates. Year of Last Vaccination: Year of Last Vaccination: Year of Last Vaccination: TB test (Mantoux) Year of Last Test: If working with primates. Year of Last Test: If working in an emergency clinical setting, respiratory ward, or with known TB patients Year of Last Test: If working in an emergency clinical setting, respiratory ward, or with known TB patients Year of Last Test: Poliomyelitis Year of Last Vaccination: If working with primates. Year of Last Vaccination: Tetanus Year of Last Vaccination: Only if working with live bacterium or toxin If working with primates. Year of Last Vaccination: Year of Last Vaccination: Year of Last Vaccination: Year of Last Vaccination: Rabies/Lyssavirus Year of Last Vaccination: Year of Last Vaccination: Q-Fever Year of Last Vaccination: Year of Last Vaccination: Employee declaration – Section D employee agreement
HR15-health-and-hazard-assessment-questionnaire.docx