<p> Risk-based Matrix of Required Health Forms, Immunizations, Tests for “Visitors” at UTHSC-H </p><p>Professional or Environment Guest* Observer* Pre-Baccalaureate Visiting UTHSC-H to be (Less than a (No hands on - no more than 2 Trainee* Scientist or Employee week - no months/dept. Cap of 6 months (No more than 4 months) (Employee Health) encountered badge access, in 5 years) Visiting Student must be Trainee* escorted) (No stated duration) CATEGORY 1 With escort, EH-1 Form "General EH-1 Form “General EH-1 Form “General EH-3 Form “Health Office or classroom no special Exposure" Exposure” Exposure” History” setting Employee Health requirements</p><p>CATEGORY 2 Escort EH-1 Form “General EH-1 Form “General EH-1 Form “General EH-3 Form “Health Research lab, accompanies Exposure” Exposure” Exposure” History” no animals, guest and • TB skin test • TB skin test • TB skin test • TB skin test no potential informs of possible • MMR bloodborne pathogen exposure • Tetanus/Tdap exposures risks, protective measures, and personal responsibility for any costs of needed healthcare CATEGORY 3 Escort EH-1 Form "General EH-1 Form “General EH-3 Form “Health EH-3 Form “Health Research lab, accompanies Exposure" Exposure” History” History” no animals, guest and • TB skin test • TB skin test • TB skin test • TB skin test but with potential informs of possible • Hep B series • MMR • MMR bloodborne pathogen exposure • Tetanus/Tdap • Tetanus/Tdap exposures risks, • Hep B series • Hep B series protective measures, and personal responsibility for any costs of needed healthcare CATEGORY 4 Escort EH-2 Form "Animal EH-2 Form “Animal EH-3 Form “Health EH-3 Form “Health Research lab, with accompanies Exposure" Exposure” History” History” animals, but no guest and • TB skin test • TB skin test EH-4 Form EH-4 Form potential bloodborne informs of “Occupational Health “Occupational Health possible • MMR • MMR pathogen exposures Enrollment”** Enrollment”** exposure • Tetanus/Tdap • Tetanus/Tdap • TB skin test • TB skin test risks, • MMR • MMR protective measures, • Tetanus/Tdap • Tetanus/Tdap and personal responsibility for any costs of needed healthcare CATEGORY 5 Escort EH-2 Form “Animal EH-2 Form “Animal EH-3 Form “Health EH-3 Form “Health Research lab, with accompanies Exposure” Exposure” History” History” animals, with guest and • TB skin test • TB skin test EH-4 Form EH-4 Form potential bloodborne informs of “Occupational Health “Occupational Health possible • MMR • MMR pathogen exposures Enrollment”** Enrollment”** exposure • Tetanus/Tdap • Tetanus/Tdap • • risks, • Hep B series TB skin test TB skin test protective • MMR • MMR measures, • Tetanus/Tdap • Tetanus/Tdap and personal • • responsibility Hep B series Hep B series for any costs of needed healthcare CATEGORY 6 Escort EH-1 Form “General EH-3 Form “Health History” EH-3 Form “Health EH-3 Form “Health Child Development accompanies Exposure” • TB skin test History” History” guest and Center (CDC), Data • TB skin test • MMR • TB skin test • TB skin test Collectors or informs of possible • MMR • Tetanus/Tdap • MMR • MMR Research Associates exposure • Tetanus/Tdap • Seasonal Influenza • Tetanus/Tdap • Tetanus/Tdap around K-12 schools risks, • Seasonal Influenza • Seasonal Influenza • Seasonal Influenza protective measures, and personal responsibility for any costs of needed healthcare CATEGORY 7 Escort EH-1 Form “General EH-3 Form “Health History” EH-3 Form “Health EH-3 Form “Health Direct patient contact accompanies Exposure” • TB skin test History” History” guest and • TB skin test • • TB skin test • TB skin test informs of MMR possible • MMR • Tetanus/Tdap • MMR • MMR exposure • Tetanus/Tdap • Hep B series • Tetanus/Tdap • Tetanus/Tdap risks, • Seasonal Influenza • Varicella • Hep B series • Hep B series protective • Varicella • Varicella measures, • Seasonal Influenza</p><p>Reviewed by Dr. George Delclos, MD Approval Date 12/12/2012 and personal • Seasonal Influenza • Seasonal Influenza responsibility for any costs of needed healthcare</p><p>Notes:</p><p>*as defined by OGHI Policy 06252012 Application instructions and procedure overview for visitors</p><p>** Occupational Health Program Enrollment occurs when visitor is added to Animal Welfare Committee (AWC) research protocol.</p><p>CATEGORY 4 – Specifically includes Visitors to Center for Laboratory Animal Medicine and Care (CLAMC)</p><p>“Bloodborne pathogens” means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV) (29 CFR 1910. 1030(b)</p><p>• TB skin test/+ chest xray required within the last 6 months, even if you received BCG vaccine as a child. OR NEGATIVE QuantiFERON- TB Gold In-Tube test (QFT-GIT) or NEGATIVE T-SPOT • MMR Measles (rubeola) vaccine: (2 are required if born after January 1, 1957) or Positive rubeola titer (attach lab report) Mumps vaccine or Positive mumps titer (attach lab report) Rubella vaccine or Positive rubella titer (attach lab report) • Tetanus/diphtheria or Tdap (Within last 10 years) • Hepatitis B vaccine series (3 injections) or positive Hepatitis B surface antibody titer (attach lab report) or Positive Hepatitis B surface antibody titer (attach lab report) • Varicella vaccine series (2 doses given at least 28 days apart) or Chicken pox disease (documented by health care provider) or positive Varicella titer (attach lab report)</p><p>Additional considerations for subset of employees such as EHS, Facilities (if around sewage, waste, or other potentially hazardous materials), CDC, HCPC, Clinical Care needed where additional services may be required including wearing respiratory protection (medical clearance, training, and fit testing)</p><p>Individuals under the age of 18 (minors) must also complete “Minors in the Workplace” form and comply with HOOP 164 http://www.uthouston.edu/hoop/policy.htm?id=1448176</p><p>Reviewed by Dr. George Delclos, MD Approval Date 12/12/2012</p>