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DEPARTMENT OF EARTH SCIENCES CONFIDENTIAL
UNI VERSI TY OF C AM BRI DGE

SAFETY/MEDICAL FORM
FOR ALL NEW MEMBERS OF THE DEPARTMENT
(PLEASE PRINT) POSITION IN DEPT …………………………………. SUPERVISOR/MANAGER ………….……….…………….…. EMAIL ………………………………………………………….ROOM NO ……………………………….……
Contact details:

.………………….…………………………….…………. ………………………………………………………………………………………………….…. ………………………………………………………………………………………………….…. Tel and mobile numbers ……………………………………………………………………………………….
Person to be contacted in an emergency:

NAME:
…………………………………………………………………………………………………………….……. ADDRESS: …………………………………………………………………………………………………………….……. …………….…………………………………………………………………………………………………. TELEPHONE: ……………………………………………………………………….………………………………………. Vegetarian
Date of last tetanus injection (approx) ………………………………………………………………………………….
Please list any medication prescribed for you:
……………………………………………………………………………………………………………………………….
Please ensure that you bring sufficient supplies of any medication which you use frequently, e.g. Ventolin and
indicate any other medical conditions which would need to be taken into account in the event of any emergency:
……………………………………………………………………………………………………………….……………….
I have read the “Cambridge University Department of Earth Sciences: Fieldwork – Code of Safe Practice and
Good Conduct” and agree to abide by it.
SIGNED ………………………………………………………. DATE ……………………………………………………
\\Fserv\health_and_safety\Safety Handbook & Forms\Web_versions\Safety_Medicalform.doc SMF –
SEPT 09

DEPARTMENT OF EARTH SCIENCES CONFIDENTIAL
UNI VERSI TY OF C AM BRI DGE

Please return this form to Nigel Johnson or Celia Hobbs (Downing Site, S032) \\Fserv\health_and_safety\Safety Handbook & Forms\Web_versions\Safety_Medicalform.doc SMF –
SEPT 09

Source: https://www.esc.cam.ac.uk/esc/files/Department/safety/Safety_Medicalform.pdf

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CAMRESEARCH Magazine for Complimentary and Alternative Medicine Professionals – United Kingdom PHYTOTHERAPY Herbals outperform antibiotics in treatment of Lyme Disease One of the world's leading Lyme Disease researchers has tested a natural treatment protocol based on the Cat's claw (Uncaria tomentosa) product Samento and Banderol (from the Otoba plant) and found that it is at le

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Allegheny Valley School District 2010 - 2011 District Goals Athletics Goal #1: Develop and adopt a Student Athletic Manual. Goal #2: Clarify, improve, and communicate the weekly process for monitoring student academic eligibility for athletics and activities. Board Policy/Administrative Procedures Goal #1: Develop Section 300 (employees) of the School Board Policy Manual.

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