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Student/Volunteer Medical Surveillance (SMSI)

UTSA students (non-employees) enrolled in educational research programs that involve working directly or indirectly with: 1) live animal research, unfixed animal tissues or wastes; 2) non-human primates with potentially infectious diseases, their blood, unfixed tissues or wastes; 3) pathogenic organisms; or 4) carcinogenic chemicals (cancer inducing drugs), toxins or other non-biological materials identified based on risk, are to be enrolled in a medical surveillance program. Similarly, persons not otherwise affiliated with UTSA (volunteers) who will be exposed to any of the aforementioned must also enroll in a occupational health program.

To begin enrollment, students/volunteers must complete the Request and Authorization form (below). The Principal Investigator (PI), Lab Supervisor or Sponsor must sign this form. Submit completed forms via fax, email or in person to the Laboratory Animal Resources Center (LARC) office in Graduate School and Research Building (GSR), Room 2.130L 2.104. Fax (210) 458-6087  Email larc@utsa.edu.

Once the LARC has granted authorization, approved forms will be returned to the enrollee.

Once the individual has received appropriate LARC authorization, they may schedule an appointment for medical evaluation through Environmental Health, Safety and Risk Management (EHSRM) by calling (210) 458-5072 (phone/fax combination #) or emailing UTSAOHP@utsa.edu.

VERY IMPORTANT: The signed Authorization form must be taken to the medical appointment to be seen.

Prior to the appointment, each student or volunteer must complete a Risk Assessment and an Animal Allergy Questionnaire. If an individual desires a more thorough evaluation, they should also complete the Health Assessment (optional). Additionally, if an individual will require use of a respirator, they should complete the Respirator Medical Evaluation Questionnaire. These forms are available below. Please submit your completed enrollment paperwork to EHSRM via fax or intercampus mail prior to your appointment.

Once all SMSI forms, test results and vaccinations required for your on-campus activities have been processed by the SMSI Licensed Health Care Professional/Provider (or your personal physician, if applicable), you and your PI/Sponsor will be notified of your medical clearance to participate in the specified activity.

FORMS
filetype-pdf Risk Assessment (PDF)
filetype-pdf Animal Allergy Questionnaire (PDF)
filetype-pdf Health Assessment (PDF)
filetype-pdf Respirator Medical Evaluation Questionnaire (PDF)
filetype-pdf Student & Volunteer (non-employee) Request and Authorization for Medical Surveillance (PDF)

 

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