Pre placement health assessment form 2026

1. Click ‘Get Form’ to open the pre-placement health assessment form in the editor.
2. Begin by filling in your personal details, including your last name, first name, initial, address, hire date, city/state, zip code, emergency contact information, sex, birth date, and phone number.
3. Next, provide your job title and division/department. Ensure that you include your social security number and family physician's name.
4. Indicate if you are taking medications regularly and list any allergies you may have. Check the relevant medical history items that apply to you.
5. Complete the work health history section by noting any previous exposures to hazardous agents and whether you are currently pregnant.
6. Fill out the immunization history and tobacco use sections accurately. Finally, review the statement of understanding before signing and dating the form.

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