UB-COVID19 vulnerability questionnaire

Detection of personnel particularly vulnerable to SARS-CoV-2 and other possible situations of particular sensitivity.

VERY IMPORTANT: This questionnaire should only be filled in if you are included or included in any of the situations of vulnerability indicated in the Risk Factors section below, and you have not been previously assessed or need updating.

More information: Medical management of vulnerability to COVID-19 in the UB.


    If for any reason you prefer not to answer the questionnaire, do not do it, contact the medical service at medicinadeltreball.ossma@ub.edu to inform us.

    Fields marked with an asterisk (*) are mandatory.

    Personal details


    Risk factors

    If you have ticked any of the above boxes, with the exception of pregnancy or being over 60 years old, please explain:

    Other diseases




    Details of your current UB on-site activities




    Interaction with other people




    I hereby declare that*:


    As the questionnaire contains medical information, it will be sent directly and only to health personnel at medicinadeltreball.ossma@ub.edu. From this address, only technical information will be forwarded to the prevention technicians. Based on the answers to the questionnaire, a medical and technical assessment will be made to determine whether there is any specific condition to be considered.

    Right to information regarding the processing of personal data

    (1) The responsible for the processing of your data is the General Secretary of the University of Barcelona. (2) The purpose of the processing is to manage the periodic monitoring of the health status of employees. (3) You have the right to access your data, rectify them, delete them, oppose their processing, request their portability and the limitation of processing, in certain circumstances. (4) You may consult the detailed information on the above-mentioned treatments