Template

Medical Declaration Form Template

by Julie Sinclair, from the Community

Use this Medical Declaration Form template to record a participant’s health condition and medications prior to work or an activity. Document the condition being declared, medications taken, dosage, storage requirements, and any emergency medication needed. Capture how the condition affects routine tasks and strenuous exercise, and note medical advice received from a doctor or nurse. Include additional information that helps manage the condition during the activity. The form also contains an acknowledgment of potential exposure to dust, fumes, extreme temperatures, and other environmental factors, plus participant signature, date, and approval details.

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

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

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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.

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Medical Declaration Form Template

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Medical History Form

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Medical History Form

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