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Medical Questionnaire

When applying for a position within our organisation, we require candidates to complete a straightforward medical questionnaire. This step is crucial as it helps us ensure that we can provide a safe and accommodating work environment for all our employees. The information gathered through this questionnaire allows us to understand any specific health needs or accommodations an applicant may require, facilitating a supportive and inclusive workplace.

Are you diabetic?
Yes
No
Do you have allergies to medications? e.g Penicillin
Yes
No
Do you have a heart condition?
Yes
No
Do you have epilepsy? Or suffer from fits?
Yes
No
Do you have allergies to treatments/ materials? e.g plasters / plastic
Yes
No
Do you have asthma?
Yes
No
Have you ever been advised for medical reasons not to do night work, shift work or any other kind of work?
Yes
No
Date
Day
Month
Year
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Contact

Office Phone: 028 9752 8855

Out of Hours: 075 9752 8855

admin@uniquehomecareni.co.uk

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