Template

Confidential Employee Health Questionnaire

by Dan Davies, from the Community

This confidential employee health questionnaire helps organizations assess fitness for work and identify any adjustments required to support safe employment. It captures personal and emergency contact details, GP surgery information, medical treatments, vision and hearing considerations, physical capabilities, work restrictions such as working at heights or with vibrating tools, and history of relevant conditions. Includes a declaration and guidance on privacy obligations and potential occupational health review.

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With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Health Questionnaire Template
Use this Health Questionnaire to collect private and confidential health information from employees or candidates. The form captures personal details, emergency contacts, GP information, current medication, recent sickness, vision and hearing, physical capability, and a full medical history including respiratory, cardiac, musculoskeletal, skin, neurological, and metabolic conditions. It supports risk assessment for fitness to work, shift or night work, working at height, manual handling, and exposure to dust or vibration. Include declarations, consent, and notes on reasonable adjustments where required. Customize fields to your policies and keep records organized for occupational health and safety.
by Maria Nolden, from the Community
Downloads: 0
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Template
Pre-Employment Health Questionnaire and Job Risk Assessment
Use this pre-employment occupational health questionnaire and job risk assessment to evaluate a candidate's fitness for work and identify workplace exposures. Capture medical history, medications, hearing and vision issues, and prior injuries, then assess potential hazards such as noise, vibration, chemicals, dust, UV, shift work, heavy lifting, and extreme temperatures. Refer applicants to an occupational health specialist when risks are identified and schedule ongoing health monitoring as needed. Supports privacy and health information obligations and helps standardize hiring compliance.
by Mark Taylor, from the Community
Downloads: 30+
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Template
Health Questionnaire
A questionnaire to highlight any health concerns
by Scott Bundy, from the Community
Downloads: 40+
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Template
New Starter Day 1 Checklist
This new starter checklist helps HR and managers complete essential day 1 onboarding tasks. Record employee and next of kin details, confirm right to work documentation, and gather bank information for payroll. Complete a medical questionnaire to identify any health considerations and workplace adjustments, including vision, hearing, mobility, and prior conditions. Use the form to note shift suitability, physical role requirements, and any past health issues. Finish with employee confirmation that information provided is accurate.
by Kelli User, from the Community
Downloads: 0
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Health Questionnaire Template

Use this Health Questionnaire to collect private and confidential health information from employees or candidates. The form captures personal details, emergency contacts, GP information, current medication, recent sickness, vision and hearing, physical capability, and a full medical history including respiratory, cardiac, musculoskeletal, skin, neurological, and metabolic conditions. It supports risk assessment for fitness to work, shift or night work, working at height, manual handling, and exposure to dust or vibration. Include declarations, consent, and notes on reasonable adjustments where required. Customize fields to your policies and keep records organized for occupational health and safety.

by Maria Nolden, from the Community

Get

Template

Pre-Employment Health Questionnaire and Job Risk Assessment

Use this pre-employment occupational health questionnaire and job risk assessment to evaluate a candidate's fitness for work and identify workplace exposures. Capture medical history, medications, hearing and vision issues, and prior injuries, then assess potential hazards such as noise, vibration, chemicals, dust, UV, shift work, heavy lifting, and extreme temperatures. Refer applicants to an occupational health specialist when risks are identified and schedule ongoing health monitoring as needed. Supports privacy and health information obligations and helps standardize hiring compliance.

by Mark Taylor, from the Community

30+

Get

Template

Health Questionnaire

A questionnaire to highlight any health concerns

by Scott Bundy, from the Community

40+

Get

Template

New Starter Day 1 Checklist

This new starter checklist helps HR and managers complete essential day 1 onboarding tasks. Record employee and next of kin details, confirm right to work documentation, and gather bank information for payroll. Complete a medical questionnaire to identify any health considerations and workplace adjustments, including vision, hearing, mobility, and prior conditions. Use the form to note shift suitability, physical role requirements, and any past health issues. Finish with employee confirmation that information provided is accurate.

by Kelli User, from the Community

Get

Confidential Employee Health Questionnaire

About author

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Health Questionnaire Template

Pre-Employment Health Questionnaire and Job Risk Assessment

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Health Questionnaire Template

Pre-Employment Health Questionnaire and Job Risk Assessment

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