Prodieco Pre-employment Questionnaire - Prodieco


The purpose of this questionnaire is to assist Prodieco in determining your fitness to carry out your duties safely in your proposed workplace in compliance with employment law.

  • Screening for medical problems will also assist your employer in meeting their obligations under Health & Safety law.
  • This questionnaire will form part of your occupational health record which will be held by Prodieco.
  • This questionnaire may be stored in paper or electronic form in compliance with data protection law for possible future reference.
Please answer all sections and questions as completely as possible. 

Please give details of any treatment you may have had such as surgery/medication and state if you are currently taking medication and/or having treatment such as physiotherapy etc.

Please answer yes or no to the following questions. If yes please give details.

Have you ever had or do you currently have:

Have you ever had or do you currently have:

I understand that the purpose of this pre–employment questionnaire is to confirm that:
  • I am fit for the position I have applied.
  • I can perform my duties safely and without risk to the health and safety of others.
  • I can render reliable and productive service for my employer
  • I declare that the information I have given is true and accurate to the best of my knowledge and that I have not withheld any material facts.
  • I understand that I am responsible for the accuracy or otherwise of the answers above.
  • I understand that if I have knowingly withheld material facts this may affect my appointment.
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