Pre-placement Occupational Health Questionnaire

  1. The purpose of this questionnaire is to exclude, if possible, the need for a full medical assessment. If an assessment is considered necessary, arrangements will be made directly with you.
  2. This questionnaire is to establish if there is a duty on the employer to make reasonable adjustments to support the post holder to be able to carry out the full functions of the post.
  3. All clinical information about any disability or medical condition will not be disclosed by Occupational Health to any third party, including the prospective employer, without the employee’s written consent.
  4. Information supplied and recorded will be kept in compliance with the Access to Medical Records Act 1988 and the Data Protection Act 1998.



Please answer all questions.


If there is any change to the information supplied above, you must inform Occupational Health prior to commencing your employment.