Large red hawk statue behind red flowers on campus

Patient Forms

For questions about completing or submitting a form, please contact the Occupational Health Department at 973-655-5014 or ohd@montclair.edu.

  1. Health Screening Questionnaire for Animal Handlers
    Animal Handlers must complete and submit this form prior to obtaining clearance to work in Vivarium facilities.
  2. Hepatitis B Vaccine Participation/Declination Form
    This form must be completed by all employees subject to the Hepatitis B vaccine program.
  3. Medical Questionnaire for Respirator Users
    Respirator Users must complete and submit this form prior to obtaining clearance to use a respirator on-the-job.
  4. Animal Handler Injury Report Form
    This form must be completed after an incident (injury or illness) has occurred while handling animals.
  5. Form for Flu Vaccination Clinic Fall 2020
    Flu clinics are offered to Montclair State University students and employees. This form must be completed prior to your appointment. For dates and times, and to schedule your appointment, click here.