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.