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COVID Vaccine Card with mask

All Forms

Incoming / New Students – Health Clearance documents.

Physical Examination – Can be used for physicals that may be required by a clinical rotation site.

TB Symptoms Health Screening Checklist – If you require a chest x-ray for TB clearance OR if you obtained IGRA (e.g. Quantiferon or T-spot) test, you must complete this form on a yearly basis.

New PPD Skin Test Converters – Provides information on what you need to do in order to obtain TB clearance if your previous tuberculosis skin tests were negative but your most recent is now positive.

Authorization to Email – Consent form you must complete, sign, and date then submit to the SEHO in order for them to email your health documents to your WesternU email.

Blood Borne Pathogen Labs – Laboratory tests you need to obtain if you had any exposure to blood, or body fluids (i.e. needle stick).

COVID-19 Related Documents

COVID-19 Positive Test Results or Exposure Reporting

COVID-19 Vaccination Medical/Disability Exemption Form

COVID-19 Vaccination Religious Exception Form

COVID-19 Vaccination Pregnancy Deferral Form