SafeWorks Forms Database

To help facilitate your visit to SafeWorks Illinois, we have posted these forms to the web site. If your physician, employer or a SafeWorks Illinois team member has indicated you will need to complete one of these forms, please feel free to download and print out the appropriate form. Instructions are listed on the form detailing where the form should be sent once completed.

To download a form, click on the form name or icon you wish to download.
Audio History Questionnaire
Drug and Alcohol Random Testing Program
HAZWOPPER Questionairre
OSHA Respirator Medical Evaluation Questionairre

If you have any technical problems or questions with these forms, please call SafeWorks Illinois at 217.356.6150.