On Employment Questionnaire – Barbers Group - Aardvark Occupational Health

This brief Health Questionnaire is to ensure your fitness for role tasks. It is important that you answer the questions accurately as it will assist both you and your employer to meet obligations set out under the Health and Safety at Work Act.

First name(s)(Required)

Telephone number(Required)

Job Role as specified on your Contract of Employment(Required)

Manager Name(Required)

Manager telephone number(Required)

Manager email(Required)

Please answer the following questions

Please give details(Required)

Any additional information

Current Health Status

Skin, Wounds & Hygiene

Medications & Medical Conditions

Recent Exposure & Travel

Food Safety Understanding

Declaration

In submitting this form you are stating you understand that if you have answered yes to any of the questions that you will be contacted by an Occupational Health Nurse to discuss this. With your consent your employer will then be advised of any reasonable adjustments that may need to be considered to assist you in maintaining your role tasks.