Medical Questionnaire

Our aim at ExcelCare24 is to ensure that our staff work in a healthy and safe environment and we are committed to promote your health and safety at work. Before we can offer you employment we would like to know if you have any health problems that could affect your ability to undertake certain tasks pertaining to your role. After the assessment we may recommend certain adjustments to enable you to perform your job.
Personal Information
GP Details
Job Details
All staff groups complete this section
Tuberculosis
Do you have any of the following
Chicken Pox or Shingles
Immunisations
Have you have any of the following immunisations
HIV – Exposure Prone (EPP) Candidates Only
HEPATITIS C - Exposure Prone (EPP) Candidates Only
Proof of Immunity (Please send the following)
Proof of Immunity (Please send the following) EPP Candidates Only
Important Information (IVS)
Exposure Prone Procedures
Recommendations
I understand that if any recommendations to my employer are necessary as a result of this Assessment.
Declaration