Please consult your Supervisor for assistance with completion. This questionnaire
is designed to identify the following information: (a) Potential exposures, hazards, and risks associated with your position. (b) Information related to performing the tasks and functions of your position.
For questions or assistance, contact MSU Safety & Risk Management: 406-994-4146 or
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If you are in a Paid Position, * If you answered 'YES' to either Animal Care & Use or Biological Agents, * If you DID check any of the task specific questions related to your
position After Safety & Risk Mgmt. receipt and review, please watch your email for instructions and completion of Part II - Occupational
Medical Surveillance Form.
If you are in anUnpaid Position, and/or * If you answered 'NO'to both Animal Care & Use and Biological Agents, and/or * If you DID NOTcheck any of the task specific questions related to your
position Please note the absence of these risk factors indicate you do not qualify for
the MSU Occupational Medical Surveillance Program. If needed, you may seek medical
consultation with this form through your own provider - for example, students may
consult with University Health Partners.
If your position, hazards, or health status changes at any time, please contact Safety
& Risk Mgmt. for assistance: 406-994-4146 or [email protected]
Safety and Risk Management Montana State University P.O. Box 170510 Bozeman, MT 59717-0510