Employee Health Services

Certificated Applicant Medical Clearance Forms Packet

Form 8459   Certificate of Medical Examination Cover Sheet
Form 8457   Certificate of Medical Examination (has two pages)
TB Risk Assessment Questionnaire (for information only)
Form 8478   TB Certificate of Completion

Certificated_Applicant_Medical_Clearance_Forms_Packet rev May 2017.pdf 601.31 KB (Last Modified on May 12, 2017)

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Tuberculosis Compliance Forms

Form 8478 TB Certificate of Completion

TB Risk Assessment Questionnaire (for information only)

Tuberculosis_Compliance_Forms_rev 11.2022 logos.pdf 421.9 KB (Last Modified on November 29, 2022)

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TB Results Form for Current Employees

Form 8472 TB Results for Current Employees only

8472_TB Test Results_04.2017.pdf 35.60 KB (Last Modified on April 18, 2017)

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Annual Declination of Influenza Vaccine

HR Form 8425

8425_Annual Declination of Influenza Vaccine_7.2017.pdf 36.83 KB (Last Modified on August 16, 2017)

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SB 792 Immunization Clearance Form

HR Form 8426

All employees working with preschool-aged children (Early Education Centers and/or Early Childhood Special Education classrooms) must complete this form.

8426_SB792 Immunization Clearance Form_7.2017.pdf 24.58 KB (Last Modified on July 27, 2017)

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