: Many health care organizations are making changes to their hazardous medication surveillance program (HMSP) in response to United States Pharmacopeia (USP) <800> standards. Absence of best practices for HMSPs and limitations on the ability of such programs to correlate health effects identified on surveillance with workplace exposures historically have left health care institutions to determine if and how to design an HMSP for their workforce. Within this article one approach to the design of an HMSP is discussed and resources such as a health questionnaire and declination form are included that could be modified or adopted by other health care organizations. This information is intended to generate further discussion and collaboration among leaders of employee occupational health services on a national level to address the benefits and challenges of HMSPs.