{"id":43013,"date":"2022-11-23T07:30:42","date_gmt":"2022-11-23T07:30:42","guid":{"rendered":"https:\/\/www.ub.edu\/ossma\/procedures-and-formalities\/covid19-vulnerability-questionnaire"},"modified":"2023-05-02T08:03:21","modified_gmt":"2023-05-02T08:03:21","slug":"covid19-vulnerability-questionnaire","status":"publish","type":"page","link":"https:\/\/www.ub.edu\/ossma\/en\/procedures-and-formalities\/covid19-vulnerability-questionnaire","title":{"rendered":"UB-COVID19 vulnerability questionnaire"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Detection of personnel particularly vulnerable to SARS-CoV-2 and other possible situations of particular sensitivity.<\/p>\n\n<p class=\"atencio wp-block-paragraph\"><strong>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.<\/strong><\/p>\n\n<p class=\"wp-block-paragraph\">More information: <a rel=\"noreferrer noopener\" href=\"https:\/\/www.ub.edu\/ossma\/wp-content\/uploads\/2021\/08\/20210727-gestio-medica-personal-vulnerable-juliol-ub.pdf\" target=\"_blank\">Medical management of vulnerability to COVID-19 in the UB<\/a>.<\/p>\n\n<h2 class=\"wp-block-heading\">Questionnaire<\/h2>\n\n<p class=\"wp-block-paragraph\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f43018-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"43018\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/ossma\/en\/wp-json\/wp\/v2\/pages\/43013#wpcf7-f43018-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"43018\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f43018-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:43018,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;malalties-mes&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;malalties&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Yes&quot;}]},{&quot;then_field&quot;:&quot;discapacitats-mes&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;discapacitats&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Yes&quot;}]},{&quot;then_field&quot;:&quot;altre-lloc-treball&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;altre-lloc&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Yes&quot;}]},{&quot;then_field&quot;:&quot;comunicar-mes&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;comunicar&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Yes&quot;}]},{&quot;then_field&quot;:&quot;contacte-mes&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;contacte-estret&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Yes&quot;}]},{&quot;then_field&quot;:&quot;group-malalties&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;risc&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;None of these risk factors&quot;}]},{&quot;then_field&quot;:&quot;group-edat&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;risc&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;You are over 60 years of age&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;repeater_remove_button&quot;:&quot;bottom&quot;}}\" \/>\n<\/fieldset>\n<div class=\"formulari-destacat\">\n\t<p>If for any reason you prefer not to answer the questionnaire, please do not do so, contact the medical service at <a href=\"mailto:medicinadeltreball.ossma@ub.edu\">medicinadeltreball.ossma@ub.edu<\/a> to inform us.\n\t<\/p>\n<\/div>\n<p><span class=\"small\">Fields marked with an asterisk (*) are mandatory<\/span>\n<\/p>\n<div class=\"form-two-columns\">\n\t<fieldset>\n\t\t<legend>Personal data\n\t\t<\/legend>\n\t\t<p><label for=\"nom\">Surnames, Name*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"nom\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"naixement\">Date of birth*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"naixement\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"naixement\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"naixement\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"nif\">NIF*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"nif\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"nif\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nif\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"relacio-ub\">Relationship with the UB*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"relacio-ub\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\" id=\"relacio-ub\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"relacio-ub[]\" value=\"PTGAS\" \/><span class=\"wpcf7-list-item-label\">PTGAS<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"relacio-ub[]\" value=\"PDI\" \/><span class=\"wpcf7-list-item-label\">PDI<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"facultat\">Faculty\/Center*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"facultat\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" id=\"facultat\" aria-required=\"true\" aria-invalid=\"false\" multiple=\"multiple\" name=\"facultat[]\"><option value=\"Complementary Training Area (Jeroni Granell)\">Complementary Training Area (Jeroni Granell)<\/option><option value=\"Complementary Training Area (El Carme Building)\">Complementary Training Area (El Carme Building)<\/option><option value=\"\u00c0rea de Formaci\u00f3 Complement\u00e0ria (\u201cTower of La Creu\u201d)\">\u00c0rea de Formaci\u00f3 Complement\u00e0ria (\u201cTower of La Creu\u201d)<\/option><option value=\"Josep Carner Classroom\">Josep Carner Classroom<\/option><option value=\"High Mountain Research Center\">High Mountain Research Center<\/option><option value=\"Baldiri Reixac 2 Building\">Baldiri Reixac 2 Building<\/option><option value=\"Hist\u00f2ric Building\">Hist\u00f2ric Building<\/option><option value=\"Sol\u00e9 i Sabar\u00eds Building (CCiTUB)\">Sol\u00e9 i Sabar\u00eds Building (CCiTUB)<\/option><option value=\"CRAI Warehouse (Cervera)\">CRAI Warehouse (Cervera)<\/option><option value=\"Faculty of Fine Arts\">Faculty of Fine Arts<\/option><option value=\"Faculty of Information and Audiovisual Media (UB Sants)\">Faculty of Information and Audiovisual Media (UB Sants)<\/option><option value=\"Faculty of Biology\">Faculty of Biology<\/option><option value=\"Faculty of Earth Sciences\">Faculty of Earth Sciences<\/option><option value=\"Faculty of Law\">Faculty of Law<\/option><option value=\"Faculty of Economics and Business Studies\">Faculty of Economics and Business Studies<\/option><option value=\"Faculty of Education\">Faculty of Education<\/option><option value=\"Faculty of Pharmacy and Food Sciences (Torribera Campus)\">Faculty of Pharmacy and Food Sciences (Torribera Campus)<\/option><option value=\"Faculty of Pharmacy and Food Sciences (Diagonal Sud Campus)\">Faculty of Pharmacy and Food Sciences (Diagonal Sud Campus)<\/option><option value=\"Faculty of Philosophy and Faculty of Geography and History\">Faculty of Philosophy and Faculty of Geography and History<\/option><option value=\"Faculty of Physics and Faculty of Chemistry\">Faculty of Physics and Faculty of Chemistry<\/option><option value=\"Faculty of Medicine and Health Sciences (Cl\u00ednic Campus)\">Faculty of Medicine and Health Sciences (Cl\u00ednic Campus)<\/option><option value=\"Faculty of Medicine and Health Sciences (Bellvitge Campus)\">Faculty of Medicine and Health Sciences (Bellvitge Campus)<\/option><option value=\"Faculty of Psychology\">Faculty of Psychology<\/option><option value=\"Pere Pons Estate\">Pere Pons Estate<\/option><option value=\"Park of Humanities and Social Sciences (Can Jaumandreu Building)\">Park of Humanities and Social Sciences (Can Jaumandreu Building)<\/option><option value=\"Pink Pavillion\">Pink Pavillion<\/option><option value=\"Sports Service\">Sports Service<\/option><option value=\"Other UB facilities\">Other UB facilities<\/option><option value=\"Other facilities outside the UB\">Other facilities outside the UB<\/option><\/select><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"departament\">Department\/service\/unit*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"departament\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"departament\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"departament\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"edifici\">Building\/s<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"edifici\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"edifici\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"edifici\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"correu\">E-mail*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"correu\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" id=\"correu\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"correu\" \/><\/span>\n\t\t<\/p>\n\t<\/fieldset>\n\t<fieldset>\n\t\t<legend>Risk factors\n\t\t<\/legend>\n\t\t<p><label for=\"risc\">Do you have any of the following risk factors?<br \/>\n<span class=\"small\">(With the Crtl. key you can select several options)<\/span><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"risc\"><select class=\"wpcf7-form-control wpcf7-select\" id=\"risc\" aria-invalid=\"false\" multiple=\"multiple\" name=\"risc[]\"><option value=\"None of these risk factors\">None of these risk factors<\/option><option value=\"Cardiovascular disease, including hypertension\">Cardiovascular disease, including hypertension<\/option><option value=\"Chronic lung disease\">Chronic lung disease<\/option><option value=\"Diabetes\">Diabetes<\/option><option value=\"Chronic renal insufficiency\">Chronic renal insufficiency<\/option><option value=\"Immunodepression\">Immunodepression<\/option><option value=\"Cancer in active treatment phase\">Cancer in active treatment phase<\/option><option value=\"Severe chronic liver disease\">Severe chronic liver disease<\/option><option value=\"Morbid obesity (BMI&gt;40)\">Morbid obesity (BMI&gt;40)<\/option><option value=\"Pregnancy\">Pregnancy<\/option><option value=\"You are over 60 years old\">You are over 60 years old<\/option><\/select><\/span>\n\t\t<\/p>\n\t\t<div data-id=\"group-edat\" data-orig_data_id=\"group-edat\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><label for=\"edat\">Age<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"edat\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"edat\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"edat\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div data-id=\"group-malalties\" data-orig_data_id=\"group-malalties\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p>If you have checked any of the above boxes, except for pregnancy or being over 60 years old, please explain:\n\t\t\t<\/p>\n\t\t\t<p><label for=\"risc-desde\">How long have you been suffering from this?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"risc-desde\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"risc-desde\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"risc-desde\" \/><\/span>\n\t\t\t<\/p>\n\t\t\t<p><label for=\"diagnostic\">What is the medical diagnosis for this risk factor?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"diagnostic\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"diagnostic\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"diagnostic\" \/><\/span>\n\t\t\t<\/p>\n\t\t\t<p><label for=\"risc-tractament\">What is your current medical treatment?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"risc-tractament\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"risc-tractament\" aria-invalid=\"false\" name=\"risc-tractament\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t\t<p><label for=\"risc-controlada\">Do you consider that your pathology is under control?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"risc-controlada\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"risc-controlada\" aria-invalid=\"false\" name=\"risc-controlada\"><\/textarea><\/span><br \/>\n<label for=\"inform-medic\">If you consider it necessary, you can attach updated medical information<br \/>\n<span class=\"small\">(Maximum size of the file: 20Mb)<\/span><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"inform-medic\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" id=\"inform-medic\" accept=\"audio\/*,video\/*,image\/*\" aria-invalid=\"false\" type=\"file\" name=\"inform-medic\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset>\n\t\t<legend>Other diseases\n\t\t<\/legend>\n\t\t<p><label for=\"malalties\">Do you have any other disease that is not on the list for which you need treatment and that you think could be incompatible with working conditions at the current time of the pandemic?* <\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"malalties\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"malalties\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"malalties\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"malalties\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div data-id=\"malalties-mes\" data-orig_data_id=\"malalties-mes\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><label for=\"malalties-explica\">If yes, if you wish, tell us your diagnosis, treatment, and current health status, and we will evaluate it<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"malalties-explica\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"malalties-explica\" aria-invalid=\"false\" name=\"malalties-explica\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset>\n\t\t<legend>Disabilities\n\t\t<\/legend>\n\t\t<p><label for=\"discapacitats\">Do you have any disability that you consider incompatible with your working conditions at the UB?*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"discapacitats\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"discapacitats\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"discapacitats\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"discapacitats\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div data-id=\"discapacitats-mes\" data-orig_data_id=\"discapacitats-mes\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><label for=\"discapacitats-explica\">If yes, please explain your personal situation and we will evaluate it<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"discapacitats-explica\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"discapacitats-explica\" aria-invalid=\"false\" name=\"discapacitats-explica\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset>\n\t\t<legend>Data about your current UB face-to-face activity\n\t\t<\/legend>\n\t\t<p><label for=\"transport\">What means of transportation do you use to get to your place of work?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"transport\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"transport\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"transport\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"temps\">How long will it take you to get to your work place?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"temps\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"temps\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"temps\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"transport-abans\">What means of transport did you use before the pandemic situation?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"transport-abans\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"transport-abans\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"transport-abans\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"lloc\">What is your usual place of work?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"lloc\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"lloc\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"lloc\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"habituals\">Your tasks at this moment are different from the usual ones and therefore, in your opinion, the activity presents some risk (other than SARS-CoV2)<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"habituals\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"habituals\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"habituals\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"horari\"><b>Habitual<\/b> schedule of your work place <\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"horari\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"horari\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"horari\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"horari-previst\">Schedule <b>predicted<\/b> and days of presence\/presential work at the moment<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"horari-previst\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"horari-previst\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"horari-previst\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"horari-docencia\">In case of PDI, weekly hours of face-to-face teaching planned, both theoretical and practical<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"horari-docencia\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"horari-docencia\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"horari-docencia\" \/><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"altre-lloc\">Do you have to access another work place different from your usual one during your stay at the UB?*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"altre-lloc\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"altre-lloc\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"altre-lloc\" value=\"S\u00ed\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"altre-lloc\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div data-id=\"altre-lloc-treball\" data-orig_data_id=\"altre-lloc-treball\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><label for=\"altre-lloc-perque\">Where? Why?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"altre-lloc-perque\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"altre-lloc-perque\" aria-invalid=\"false\" name=\"altre-lloc-perque\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><label for=\"eina\">Do you use any equipment, furniture, material that is also used by other colleagues or employees and may represent a risk of contamination?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"eina\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"eina\" aria-invalid=\"false\" name=\"eina\"><\/textarea><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"neteja\">Is there a cleaning service for the furniture and facilities you use?*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"neteja\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"neteja\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"neteja\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"neteja\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"productes\">In case you make an additional cleaning of the furniture or materials you use, do you have the appropriate products and protection elements? What are these?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"productes\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"productes\" aria-invalid=\"false\" name=\"productes\"><\/textarea><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"comunicar\">If you are alone, do you have regular contact (telephone? face-to-face?) with someone during the time you are at your workplace in case you have to communicate an emergency situation?*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"comunicar\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"comunicar\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"comunicar\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"comunicar\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div data-id=\"comunicar-mes\" data-orig_data_id=\"comunicar-mes\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><label for=\"comunicar-qui\">With whom?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"comunicar-qui\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"comunicar-qui\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"comunicar-qui\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset>\n\t\t<legend>Interaction with other people\n\t\t<\/legend>\n\t\t<p><label for=\"contacte-estret\">Do you consider that your job requires at some point to have a close contact at your place of work? <span class=\"small\">(*Close contact = any person who has been in the same place as the case at a distance of less than 2 meters for at least 15 minutes without adequate protection)<br \/>\n<\/span><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"contacte-estret\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"contacte-estret\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"contacte-estret\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"contacte-estret\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div data-id=\"contacte-mes\" data-orig_data_id=\"contacte-mes\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><label for=\"contacte-estret-explica\">Explain the situation<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"contacte-estret-explica\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"contacte-estret-explica\" aria-invalid=\"false\" name=\"contacte-estret-explica\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset>\n\t\t<legend>Tasks\n\t\t<\/legend>\n\t\t<p><label for=\"tasques\">Indicate briefly what are the tasks that you will perform at your usual place of work (on-site and telecommuting) and that have led you to think that, being vulnerable, they represent a risk to your health<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"tasques\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"tasques\" aria-invalid=\"false\" name=\"tasques\"><\/textarea><\/span>\n\t\t<\/p>\n\t<\/fieldset>\n\t<fieldset>\n\t\t<legend>Signature\n\t\t<\/legend>\n\t\t<p>I declare that*:\n\t\t<\/p>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"aceptacio-certes\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"aceptacio-certes\" value=\"1\" id=\"aceptacio-certes\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">the information I have provided in this questionnaire is true<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"aceptacio-canvis\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"aceptacio-canvis\" value=\"1\" id=\"aceptacio-canvis\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I will inform the OSSMA in case of any modification of my situation<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label for=\"signatura\">Signature of the worker*<br \/>\n<small>(Draw your signature in the box)<\/small><\/label>\n\t\t<\/p>\n\t\t<div class=\"formulari-dreta\">\n\t\t\t<p><div class=\"dscf7_signature\">\n\t\t\t<div class=\"dscf7_signature_inner\">\n\t\t\t\t<canvas id=\"digital_signature-pad_signatura\" name=\"signatura\" class=\"digital_signature-pad\" color=\"#000000\" backcolor=\"#dddddd\" width=\"300\" height=\"200\"><\/canvas>\n\t\t\t\t<input class=\"clearButton\" type=\"button\" value=\"+\">\n\t\t\t<\/div>\n\t\t\t<span class=\"wpcf7-form-control-wrap signatura\" data-name=\"signatura\">\n\t\t\t\t<input class=\"wpcf7-form-control wpcf7-signature wpcf7-validates-as-required wpcf7-validates-as-signature dscf7-signature\" id=\"signatura\" value=\"\" type=\"hidden\" name=\"signatura\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"signatura-attachment\" class=\"wpcf7_input_signatura_attachment\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"signatura-inline\" class=\"wpcf7_input_signatura_inline\"\/>\n\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<div class=\"ressaltat\">\n\t\t<p>IMPORTANT:\n\t\t<\/p>\n\t<\/div>\n\t<p>Since 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 if there is any specific condition to be considered.\n\t<\/p>\n\t<p><b>Right to information regarding the processing of personal data<\/b>\n\t<\/p>\n\t<p>(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 portability and the limitation of processing, in certain circumstances. (4) You can consult the <a href=\"https:\/\/www.ub.edu\/ossma\/en\/right-information-data-processing\/right-information-data-processing-medical-examination\" target=\"_blank\">detailed information on the above-mentioned treatments<\/a>.\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptacio\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptacio\" value=\"1\" id=\"acceptacio\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I declare that I have read the right to information and I consent to the processing of my personal data in the terms indicated.<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p>\n<p>(The form may take a few seconds to confirm submission. Please do not resend it or reload the page)\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"236\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"<p class=\"wp-block-paragraph\">Detection of personnel particularly vulnerable to SARS-CoV-2 and other possible situations of particular sensitivity.<\/p>\n","protected":false},"author":1,"featured_media":27793,"parent":27961,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":"","footnotes":""},"class_list":["post-43013","page","type-page","status-publish","has-post-thumbnail"],"coauthors":[],"author_meta":{"author_link":"https:\/\/www.ub.edu\/ossma\/en\/author\/ossmau1","display_name":"OSSMA"},"relative_dates":{"created":"Posted 4 years ago","modified":"Updated 3 years ago"},"absolute_dates":{"created":"Posted on 23\/11\/2022","modified":"Updated on 02\/05\/2023"},"absolute_dates_time":{"created":"Posted on 23\/11\/2022 7:30","modified":"Updated on 02\/05\/2023 8:03"},"featured_img_caption":"","featured_img":"https:\/\/www.ub.edu\/ossma\/wp-content\/uploads\/2021\/04\/banner-notificacions.jpg","series_order":"","_links":{"self":[{"href":"https:\/\/www.ub.edu\/ossma\/en\/wp-json\/wp\/v2\/pages\/43013","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ub.edu\/ossma\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ub.edu\/ossma\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ub.edu\/ossma\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ub.edu\/ossma\/en\/wp-json\/wp\/v2\/comments?post=43013"}],"version-history":[{"count":3,"href":"https:\/\/www.ub.edu\/ossma\/en\/wp-json\/wp\/v2\/pages\/43013\/revisions"}],"predecessor-version":[{"id":47478,"href":"https:\/\/www.ub.edu\/ossma\/en\/wp-json\/wp\/v2\/pages\/43013\/revisions\/47478"}],"up":[{"embeddable":true,"href":"https:\/\/www.ub.edu\/ossma\/en\/wp-json\/wp\/v2\/pages\/27961"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.ub.edu\/ossma\/en\/wp-json\/wp\/v2\/media\/27793"}],"wp:attachment":[{"href":"https:\/\/www.ub.edu\/ossma\/en\/wp-json\/wp\/v2\/media?parent=43013"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}