Prodieco Pre-employment Questionnaire - Prodieco

PRE-EMPLOYMENT QUESTIONNAIRE

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.
Instructions:
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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