Occupational Health Services Program Enrollment

Occupational Health Services Program Enrollment

All principal investigators (PI) and research staff performing animal procedures must complete two requirements prior to Animal Study Protocol (ASP) or addendum approval:

AALAS Online Training
Occupational Health Services (OHS) Program Enrollment

Please follow this link for more information on IACUC onboarding: https://iacuc.northwestern.edu/getting-started/training.html

All individuals listed on an ASP must initiate the OHS process prior to IACUC submission. This process may occur concurrently with the IACUC review and approval process. However, official approval will not be granted unless enrollment requirements are met.

All personnel must renew OHS enrollment every three years.

Research Personnel Information

Status at Northwestern University*

If this is your first time enrolling in OHS at Northwestern University, you are considered new.

If you have an eIACUC profile, you are considered established.

New

Established

Organization Affiliation*

Northwestern University

Lurie Children's Hospital

SR AbilityLab

Laboratory Role*

Principal Investigator

Study Staff

First Name*

Middle Initial

Last Name*

Date of Birth*

Occupation/Job Title*

Net ID*

This is NOT your employee ID.

This will be 3 letters followed by 3-4 numbers, e.g. nwu1851.

Phone Number*

This is so the health service provider can contact you if they need to follow up with your results.

Phone

Your Northwestern Email*

Laboratory Information

Department*

The name of the academic department with which your research is associated.

Select

Laboratory Contact Number*

Ask your PI or lab manager if you are unsure.

Phone

PI's Name*

PI's Email Address*

Lab Manager's Name

Including your lab manager may quicken your clearance.

Lab Manager's Email Address

Laboratory Address*

Use the format "Building Floor-Room Number." e.g. Rubloff 7-730.

Do not include street address.

Species you will work with:*

Select or enter value

Special Requirements

Service Requested

Health History Evaluation

This is required for every researcher unless a valid OHS clearance is already on file.

YOU WILL NEED TO FILL OUT A HEALTH HISTORY QUESTIONNAIRE BEFORE YOU CAN BE CLEARED.

CONTINUE TO CHECK YOUR INBOX AND SPAM FOLDER FOR COMMUNICATION FROM THE OCCUPATIONAL HEALTH PROVIDER.

Justification for Not Selecting "Health History Evaluation"*

All employees seeking to enroll in OHS must complete the Health History Evaluation. Without a Health History Evaluation, you cannot complete enrollment and you are not eligible to work with animals. This applies for reenrollment as well.

There are no exceptions.

If you have unselected this option, please provide your explanation.

Service Provider

The rest of the OHS Enrollment process will vary based on campus location: Chicago Campus or Evanston Campus.

Laboratory Campus*

The service provider is based on the location of the laboratory you will be working in.

Chicago Campus (Corporate Health)

Evanston Campus (OMEGA)

CHICAGO CAMPUS

After reviewing this form, the IACUC Office will sign it and forward it on to Corporate Health.

You will be sent a direct email with a link from Corporate Health containing the Corporate Health Medical Questionnaire for Accessing Animal Facilities. You must complete this questionnaire to be cleared.

CHECK YOUR INBOX REGULARLY. Be sure to check your spam folder.

You cannot be added to protocol nor enroll in CCM training before you have received a clearance decision email from acuc@northwestern.edu.

EVANSTON CAMPUS

The IACUC Office will review and sign this form if it is complete and accurate. Once the authorization form has been submitted by the IACUC Office, please follow these steps:

Download the Evanston questionnaire
Submit it by e-mail to two recipients: msanhamel@northshore.org and kgreen@northshore.org
OR deliver it by hand for review and clearance to: NorthShore OMEGA 2150 Pfingsten Rd #3000, Glenview, IL 60026.

*Please send this form to NorthShore OMEGA and NOT to the IACUC Office.

You cannot be added to protocol nor enroll in CCM training before you have received a clearance decision email from acuc@northwestern.edu.

Researcher Acknowledgment*

By checking this box, I understand that these tests are being provided to me as an employee of Northwestern University and that the results of these tests will be reported to and maintained by my employer in accordance with Federal, State and local regulations.

Send me a copy of my responses

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