All employees, students, volunteers, visiting researchers, and non-UC collaborators who are listed on an Animal Care and Use Protocol or work with live, vertebrate animals in research or teaching are required to complete the risk assessment in the UC Merced Animal Care and Use Occupational Health Program.
The Principal Investigator and all personnel listed on an Animal Care and Use Protocol must be cleared PRIOR to initiating any work with animals.
Instructions to Enroll in Occupational Health and Safety Evaluation
The Occupational Health and Safety Evaluation consists of three (3) forms:
- UC Merced Confidential Medical Information, Health Surveillance Questionnaire for Animal Contact and Significant Biological Agents
- UC Merced, Risk Assessment: Animal Care and Use and Hazardous Agents
- Respiratory Protection Program, Medical Evaluation Health Questionnaire
Obtain a copy of the UC Merced, Risk Assessment: Animal Care and Use and Hazardous Agents. In consultation with the PI, the PI will complete (Sections B, C, D), and the participant will complete Sections A, E.
The participant obtains and completes (**on their own**)
• the confidential UC Merced Confidential Medical Information, Health Surveillance Questionnaire for Animal
Contact and Significant Biological Agents. Attach any additional sheets as necessary for any medical conditions that were not captured on this form. **Please complete this form on your own**, and
• the confidential Respiratory Protection Program, Medical Evaluation Health Questionnaire. **Please complete this form on your own**
After obtaining and completing all three (3) forms:
• Place all three (3) forms in an envelope,
• Seal the envelope,
• Sign in ink across the area where the envelope has just been sealed
• Mail the envelope: Individuals may then do one of the following
• Mail the forms to the Sansum Clinic Occupational Health Physician, or Directly to the Sansum Clinic Occupational Health Physician:
Ayomidamope (Ayo) Adebiyi MSN, APRN, FNP-BC, CEN, COHC
Onsite Occupational Health Nurse Practitioner
The University will mail the three (3) completed forms for you. Place the sealed, signed envelope with your name printed on the front of the envelope in the file folder “COMPLETED OCC HEALTH FORMS” in the DARS Office (Science and Engineering 1, Room 013D), just inside the door. We will forward these
forms for you, but the three (3) Occupational Health forms must be in a sealed envelope.
After the Occupational Health and Safety Physician completes the Review
1. There are four (4) possible OHS Physician review outcomes:
a. Cleared for Participation,
b. Cleared for Participation with Recommendations,
c. Not Cleared, and
d. Require Physical Examination or other assessments/requirements
If you received a clearance notice that includes follow-up items, such as a recommendation, these
items must be resolved before receiving final clearance for working with animals.
If you are Cleared for Participation, you and your PI will be notified by the IACUC Coordinator.
Occupational Health and Safety Evaluation Instructions
If you are Cleared for Participation with Recommendations, the IACUC Coordinator will contact
you and your PI regarding these recommendations. Most common recommendations include immunizations
(e.g., tetanus) or enrollment in the EH&S Respiratory Protection Program:
• If vaccination is recommended, a vaccination verification/waiver form will be sent to the animal users and PI. This form must be completed and returned to the IACUC Office before the animal user can be cleared for working with animals.
• If enrolling in the Respirator Protection Program has been recommended, the IACUC Coordinator will put the animal user in contact with the personnel responsible for administrating the program.
If you are Not Cleared, contact the IACUC Coordinator.
If you Require Physical Examination or other assessments or requirements (e.g., tetanus vaccination)
before clearance, you may obtain these from your primary care physician (or physician of
Upon meeting all requirements, the IACUC Office will email the participant and their PI informing them they are cleared for animal work.