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Night Worker Questionaire

You do not have to take up the offer of completing the health questionnaire.

If you do not wish to accept this offer, please inform your manger or HR and shut the page.

If you do wish to accept this offer, the questionnaire, is designed to identify possible areas of medical need in relation to night work.
Have you previously completed a Night Worker Questionnaire with Aardvark Occupational Health?(Required)
Date of birth(Required)

Health Questions

Please answer all the following questions:
Do you have any of the following medical conditions impacting on completion of the workplace tasks?(Required)

Declaration

I understand in submitting this form: I agree to a certificate of fitness being forwarded to my Employer either provided or after contact with a Occupational Health Nurse Advisor (if I have answered YES to any question above)