Post Offer Medical Questionnaire First Name Last Name Date of Birth Department Post Applied For School Applied to Full Home Address Post Code Home Tel Number Mobile Tel Number Email Address Preferred method of contact Home Tel Mobile Tel Email Recruiting Manager Name Recruiting Manager Email Your answers to the following will be CONFIDENTIAL to Occupational Health and will not be given to anyone else without your explicit permission. Our aim is to support and maintain the physical and mental health of all people at work. The purpose of the assessment is to see whether you have any health problems that could affect your ability to undertake the duties of the post you have been offered, or place you at any risk in the workplace. In the consultation with you, we may recommend adjustments or assistance as a result of this assessment to enable you to do the job. Occupational Health may contact you to request further details. Please provide detailed information below failure to do so will delay your recruitment. – Do you have any physical and/or mental health condition(s) or Yes disability? No If yes, please provide details Do you feel this will affect your work in this role (based on what you Yes know from the job description, interview and any previous experience)? No If yes, please provide details
Post Offer Medical Questionnaire First Name Last Name Date of Birth Department Post Applied For School Applied to Full Home Address Post Code Home Tel Number Mobile Tel Number Email Address Preferred method of contact Home Tel Mobile Tel Email Recruiting Manager Name Recruiting Manager Email Your answers to the following will be CONFIDENTIAL to Occupational Health and will not be given to anyone else without your explicit permission. Our aim is to support and maintain the physical and mental health of all people at work. The purpose of the assessment is to see whether you have any health problems that could affect your ability to undertake the duties of the post you have been offered, or place you at any risk in the workplace. In the consultation with you, we may recommend adjustments or assistance as a result of this assessment to enable you to do the job. Occupational Health may contact you to request further details. Please provide detailed information below – failure to do so will delay your recruitment. Do you have any physical and/or mental health condition(s) or Yes disability? No If yes, please provide details Do you feel this will affect your work in this role (based on what you Yes know from the job description, interview and any previous experience)? No If yes, please provide details
PostOfferMedicalQuestionnaire.docx