Respiratory HS Employee (#34)

 

Respiratory Health Surveillance

COSHH Regulations 2002

Introduction and Confidentiality Note

 

Because you work with substances that can affect your breathing, your employer has asked us to carry out a respiratory health check (health surveillance). This helps us spot any early respiratory problems so they can be dealt with quickly.

Your respiratory health surveillance involves:

  • This Questionnaire.

  • Spirometry and chest examination at a later stage by one of our clinicians.

If we notice significant respiratory issues, we may arrange for you to see our occupational health doctor for further advice.

Confidentiality: Your answers and medical results are strictly confidential. Your employer will not see them. They will only receive a brief certificate stating whether you are fit for work and if any workplace adjustments are needed.

 

Thank you for completing the form,

WorkAble Occupational Health

 

 

 

Your personal information

 


Your Respiratory Exposure History


Your current respiratory health


50

Your Medical History


Additional details


New Symptom Reporting

 

Important. If you experience new respiratory symptoms before your follow-up (usually in 12 months), please report them to your manager to get referred to occupational health as soon as possible.

Declaration and consent