Health Screening Questionnaire

This form should be completed by the employee and returned to your employer.

This information is collected in the company’s legitimate interest to ensure that we meet our duty of care for our employees. The information provided on this form will be used by the organisation to determine if it is safe for you to undertake a work task or if the activities that you are required to undertake will exacerbate any pre-existing medical conditions. The form will be handled in strict confidence and all information stored according to the requirements of the applicable data protection legislation – for more information please see our privacy notice.

Based on the information provided, we may need to seek advice from a doctor, or occupational health specialist. It may also be necessary for you to regularly attend health surveillance during your employment if determined by the company risk assessments or medical practitioner. Advice regarding fitness for work will be accessible to management in general terms, however, detailed clinical information will not be revealed without your consent.

If further information is required from your doctor or health specialist, this will only be obtained with your written consent.