Your employer has asked us to assess you. If you agree, please complete this form in confidence before the OH consultation. It helps our doctor understand your health and advise on your fitness for work, and any workplace adjustments you may need.
Your responses are confidential and will only be shared with Workable OH.
We follow GDPR and the Data Protection Act 2018. For more information, visit www.workableoh.uk/policies/confidentiality/
Please answer all questions thoroughly. Thank you.
If you answer 'yes' to any questions, please give your diagnosis, when you recurrent symptoms, treatment and any support you feel you might need.
I declare that the information I have provided about my health is true and correct to the best of my knowledge.
I understand the purpose of the occupational health assessment and consent to participate in it.
I consent to Workable OH processing my clinical information, which will be shared only with authorised Workable OH staff.
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