Thomas Cook - Decrease in Medical Fitness

Thomas Cook - Decrease in Medical Fitness - Returning from Maternity Leave

This questionnaire must only be completed if you are returning to work in less than one calendar month.

The information provided in this questionnaire will be treated confidentially and will not be passed on to your employer. The employer will only be advised of the outcome of the assessment in terms of ‘fit’ or ‘not fit’.

Please note that incorrect or incomplete forms will not be processed and you will be asked to resubmit the questionnaire.


First Name
Last Name
Date of Birth
Staff Number
Telephone Number
Email Address
When to you plan to return to work?
Date of Birth of the child
Have you suffered with any complications while giving birth or during the pregnancy?
Please provide details
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Details

If you answsered yes, please provide details

Have you suffered with post natal depression?
Please provide details.
Please move to the next question.
Details

If you answered yes, please provide details here:

Have you been started on any medication?
Please provide details.
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Details

If you answsered yes, please provide details

Have you had any other health problems during your parental leave?
Please provide details.
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Details

If you answsered yes, please provide details

Please provide details as to the nature of the health problem(s), duration of symptoms and type of health care you have received.

I hereby declare that I have carefully considered the statements made here and that to the best of my knowledge they are complete and correct and that I have not withheld any relevant information or made any misleading statement