You can be assured that the information will remain confidential to the Occupational Health Service and Doctorcall and will not be given to anyone else without your written permission.
It is important that your answers are accurate and that you do not withold any facts, not only to ensure that the company complies with legislation but for your own health and safety.
Depending on your answers and the nature of your proposed work you may be asked to attend for further screening before any offer of employment is confirmed.
We may recommend adjustments or assistance as a result of this assessment to enable you to do the job. Our aim is to promote and maintain the health of all people at work. You may be contacted by the OH team.
Please provide details of your last 3 jobs
If you have ansswered 'Yes' to any of the above questions, please provide details here:
How many days have you been absent from work due to illness in the last 2 years?
Please give dates, number of occasions, total number of days and reasons.
I hereby declare that the foregoing information is true and correct to the best of my knowledge.
In accordance with the Data Protection Act 1998 the information submitted here will be used for medical purposes only and will not be released to anyone who does not require it for this purpose. Any recommendations made on the basis of this assesment may be forwarded as necessary. The information will be placed in your Occupational Health file.
To send your responses, click Submit below.