Respiratory Medical Clearance Forms
If you need a medical clearance questionnaire, see below.
If you have already turned in a medical clearance questionnaire and have questions about whether or not you have been cleared, call Employee Occupational Health and Wellness (EOHW) at 919-684-3136.
Large Groups (25 or more employees):
If your work area is listed below, fill out the appropriate form and email it to Employee Occupational Health and Wellness at EOHW21@dm.duke.edu.
- COVID/SARS, TB, and other Airborne Pathogens
- Duke Police
- Emergency Department and Life Flight
Please call 919-684-5996 to get the appropriate questionnaire. It can be emailed or hand-delivered to you. DO NOT use any of the above questionnaires, because they do not have the correct respirator and hazard information for your work area.
If you have questions about the medical portion of the form, or to find out your medical clearance status, please call EOHW at 919-684-3136. If you have questions about filling out the first two pages of the form, please call OESO at 919-684-5996.