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  • Prairie View A&M University

    Prairie View A&M University

    Occupational Health Medical Enrollment

  • Why am I being asked to complete this enrollment?
    The Occupational Health Program (OHP) at Prairie View A&M supports employees and students that work with animals, biological materials, and other potential hazards.  OHP promotes health and safety by identifying and mitigating risks through education, prevention, medical screening, and monitoring. 

    Please complete this secure enrollment form. 

    • Enrollment is valid for one year and is required for employees and eligible students including those who work with animals or are listed in an IACUC or IBC protocol.
    • The University recommends that enrollees update this information any time they change jobs, perform new work activities, or experience a change in health status.
    • If you have questions about this form or OHP enrollment, contact RMS at (936) 261-1747 or OHP@pvamu.edu.
    • If you have questions or require assistance, you may also contact the Occupational Medicine provider directly at (979) 393-0161 or info@uohpartners.com
    • HELPFUL HINT: on mobile devices: you may be able to use microphone to dictate answers.
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    • Part 1. Animal, Pathogen, Human/primate, Hazards 

    • Please check ALL that apply:

    • Part 2. Work Environment 

    • Other potentially infectious materials (OPIM) in humans or non-human primates:

      • All body fluids where it is difficult or impossible to differentiate between body fluids
      • Amniotic fluid
      • Any body fluid visibly contaminated with blood
      • Any unfixed tissue or organ (other than intact skin) from a human or non-human primate (living or dead) 
      • Blood, organs, or other tissues from experimental animals infected with bloodborne pathogens
      • Cell, tissue, or organ cultures 
      • Cerebral spinal fluid
      • Culture media or other solutions containing bloodborne pathogens
      • Pericardial fluid
      • Peritoneal fluid
      • Pleural fluid
      • Saliva in dental procedures (whether or not there is visible blood present)
      • Semen
      • Synovial fluid
      • Vaginal secretions

    • This is to advise you that if you are accidentally exposed (needlestick, cut, mucous membrane splash), antiviral medication prophylaxis may be recommended ASAP.   Please report any potential exposure to your manager and TAMU Biosafety without delay.

    • After completing this form, you will receive an email with information on how you can contact EHS should a need arise. (You may need to check your spam/junk folder)

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    • Part 3. Health and Respirator Use 
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    • ->RECOMMENDATION:  You are overdue for Tetanus vaccination

    • --RECOMMENDATION: Tetanus vaccination is recommended every 10 years.

    • --RECOMMENDATION: The reviewer will determine if Hepatitis B vaccine is recommended for work

    • --RECOMMENDATION:  The reviewer will advise regarding eligibility for Rabies vaccine after review of your animal work.

    • --RECOMMENDATION:  A free Travel Health report can be obtained from info@uohpartners.com upon request.


    • After completing this form, you will receive an email with information on Laboratory Animal Allergy Prevention.  (You may need to check your spam/junk folder)






    • After completing this form, you will receive an email with information about reproductive hazards related to workplace exposure. (You may need to check your spam/junk folder)

    • Part 4. Signature 

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      Please certify by signing that you have completed this form to the best of your knowledge for review by the Occupational Medicine provider. Then complete by pressing SUBMIT.

    • Clear
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