Sizewell C Pre Placement Questionnaire

 

 

 

This questionnaire is used to assess your fitness to undertake your contractual duties whilst on site. We will offer advice on any adjustments to accommodate ongoing health conditions, however if you declare a health condition that requires a specialist Occupational Health opinion, we reserve the right to refer you back to your employer to obtain this, before allowing you to work. Please refer to our privacy notice Privacy Notice We may also need to gain further evidence by undertaking an assessment or by contacting your GP and/or Treating Specialist. We will only do these with your consent. This form is confidential and upon completion will be passed to the SZC Occupational Health Service directly and will form part of the employee/contractor’s occupational health record. Please complete all sections If you have dyslexia or any reading or writing difficulties and need help completing this form, please let us know.

  • The organisation you will be working for

  • Personal details

  • MM slash DD slash YYYY
  • If you have answered “Yes” to any of the questions above, please provide further information to the Site Occupational Health Professional when requested.
    • I declare that all foregoing statements are true to the best of my knowledge. I further declare that I have not omitted or falsified any material facts or details, which could have a bearing on the assessment.
    • I understand that if my health status changes at any point during my time on site, I must advise the site management immediately.
    • I understand that I may be required to attend a medical consultation and/or undergo a physical examination, subject to further consent.
    • I understand that although this form will be treated in medical confidence, further medical information may be requested from my doctor or Treating Specialist, if considered necessary, subject to further consent.
    • I consent to the results of the assessment to be processed, and a fitness certificate provided to the ‘site’ employer.
    • I consent for SZC Occupational Health to process my personal information, as defined by the current data protection legislation. Further information is available in the ‘Data Protection Guide’.

  • Please click ‘submit’ once completed. The occupational health team will be in touch should we need any further information.

Sign up to the Gipping Newsletter

Get all of our latest news and insights right into your inbox.