Printable blank AUHSP Medical Evaluation Form

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What is an AUHSP Medical Evaluation Form?

The fillable AUHSP Medical Evaluation Form is issued by the Cornell University Animal User Health and Safety Program in order to gather the necessary health information about new program participants before involving them in the research. Additional forms are not required 

What I need the AUHSP Medical Evaluation Form for?

This form is used for gathering valuable health information about procedure applicants and lets the organization avoid unwanted consequences and responsibility in case a participant reports misinformation. 
Fill this form to know if you qualify for the Cornell University AUHSP and don’t fill it if you already know that your condition is unacceptable.

How to fill out AUHSP Medical Evaluation Form?

To fill out the blank properly, you need to:

  1. Provide personal information – full name, M.I., phone number, facility address, Cornell ID number, e-mail, and PI/supervisor name;
  2. Report the last tetanus immunization year (Every 10 years is recommended);
  3. Select the answers that apply to your condition. The questions relate to asthma, allergies, skin issues, and the details of your treatment. Make sure to report the actual symptoms and their severity;
  4. Report if there are any risks related to pregnancy, compromised immunity, or sheep exposure;
  5. Check all the injuries and illnesses that took place during the last 12 months;
  6. Request details upon your personal work-related concerns if needed;
  7. Sign and date the form.

To download AUHSP Medical Evaluation Form PDF, you have to create a free account on PDFLiner to access our online form library. It lets you not only download but also print the form directly from the website.

Organizations that work with AUHSP Medical Evaluation Form:

  • Cornell University Research Department / Animal User Health and Safety Program;
  • Cornell Health Occupational Medicine.

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