The University of Texas at Dallas

The University of Texas at Dallas

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The University of Texas at Dallas

Occupational Health Verification Permit Request

Individuals in the Occupational Health Program will need to cerify their enrollment and complete their required training in Safety Skills each year.


For "Location", please indicate the workspace (class, laboratory, or area) where the work is performed.


If you would like to upload any documentation (pictures, etc.), please feel free to do so in the "Add Supporting Documents" section.


This Occupational Health Verification form is classified as an "incident report" type in CampusOptics, however, it is primarily used to certify your continued participation in the program after completing the intake form with UTSW.


If you have questions about this form or the Occupational Health Program, please reach out to the Occupational Safety team at safety@utdallas.edu.

Requester

* Required
* Required
* Required
* Required

Permit Date & Time

* Required
* Required
* Required
* Required

Location

* Required

    Basic Information

    * Required

    Add Supporting Documents

    Add files to upload as supporting documentation along with your permit request.