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Occupational Health Questionnaire

The essence of this questionnaire

The essence of this questionnaire is to ensure that you are fit for the role you applied for and to protect both you and the patients you will attend to. Your health and well-being are important to us, and this information will be kept confidential and used for the purpose of ensuring your well-being at the workplace.

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Name
Have you ever been diagnosed with tuberculosis (TB) in the past?
Check any of the following symptoms that you have experienced in the last two weeks
Have you had vaccine for tuberculosis (BCG) ?
Have you traveled outside of the United Kingdom in the last 12 months?
Have you ever had chickenpox (varicella) in the past?
Have you received the chickenpox vaccine (varicella vaccine)?
Have you received Polio Vaccine?
Have you received Tetanus Vaccine?
Have you received Hepatitis B Vaccine?
Have you received Hepatitis Booster?
Check the BOX below to confirm the accuracy of all your form inputs

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