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PRE-PLACEMENT - HEALTHCARE WORKER QUESTIONNAIRE

Strictly Confidential

Important



Your answers to this questionnaire will remain confidential to the Workplace
Health & Wellbeing team and will not be given to anyone else. The disclosure of
any physical or mental health issues will not necessarily put you at any
disadvantage for the post.

The purpose of the questionnaire 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 to advise on any adaptations or modifications that may be required to
assist you in performing the tasks of the job.

In addition, we wish to ensure that you will not be placed at risk in the
workplace and to help identify if there is a risk of developing work related
illness from any health hazards in the post. An appointment with an Occupational
Health Adviser or Physician may be required following receipt of this
questionnaire.

This Pre-Placement Form will comprise part of your Occupational Health record
once submitted. If you do not take up the post your completed form will be
destroyed within 12 months.  

All Occupational Health records are held in accordance with the Data Protection
Regulation (GDPR) and Access to Medical Reports Act (1988). Electronic
Occupational Health records are stored on a secure server which can only be
accessed by the Occupational Health team using log in / passwords. Paper records
are stored securely in locked cabinets and only the Occupational Health team
have access to the keys. Access to the office is restricted to Occupational
Health or authorised staff only. The office is locked during out of office hours
so no one can access any information.

If you wish to view or receive a copy of your Occupational Health records held
by Workplace Health & Wellbeing, we require a formal request and we will respond
to your request within one month


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