New Starter Clinical Form

For a Fitness to Work certificate to be issued, we require you to complete the following questionnaire.

When completed, we will send the form along with your Immunisation reports to our Occupational Health partner (Healthier Business) who will conduct an assessment and issue the Fitness to Work certificate.

To get started, please tap Next.

Confidential

Due to the nature of the role you have applied for we need to carry out an assessment of a new starter health questionnaire – even if you have been employed in UK health services before. The health of each candidate is considered individually and a decision regarding fitness for work in the prospective job role will be based on the functional effects of any underlying health condition/disability/impairment as well as health service requirements for fitness and immune status.

Before health clearance is given for employment you may be contacted by telephone from a clinician at Healthier Business UK Ltd, however you may also need to be seen by an occupational health advisor/specialist or physician, arrangements for face to face consultations will be arranged by your employer or agency. We may recommend adjustments or assistance following an assessment to enable you to carry out your proposed duties safely and effectively. Recommendations to your employer will be directed to essential information regarding your health and the hazards and risks of your employment and with due reference to other relevant statutory requirements and professional practice. Our aim is to promote and maintain the health of all individuals in the workplace: staff, service users and third parties. Your records will be retained electronically in accordance with best practice and the requirements of the General Data Protection Regulations. Your records will be held on file for the purposes of processing your request only and for no longer than is necessary, however your records may be subject to internal clinical audits. Your records may also be used to cross reference and ascertain your fitness should you register with other clients of Healthier Business UK Ltd.

All staff groups are required to provide the following:

• Varicella
  You must provide a written statement to confirm that you have had chicken pox or shingles however we strongly advise that you provide serology test result showing varicella immunity.
• Tuberculosis
  We require an occupational health/GP certificate of a positive scar or a record of a positive skin test result (Do not Self Declare).
• Rubella, Measles & Mumps
  Certificate of “two” MMR vaccinations or proof of a positive antibody for Rubella and Measles.
• Hepatitis B
  You must provide a copy of the most recent pathology report showing titre levels of 100lu/l or above.

EPP Candidates only are required to also provide the following:

• Hepatitis B Surface Antigen
  Evidence of Hepatitis B Surface Antigen Test (Inc. ‘e’ antigen and DNA viral loads if applicable. Report must be an identified validated sample. (IVS)
• Hepatitis C
  Evidence of a Hepatitis C antibody test (Inc. Hepatitis C RNA/PCR if applicable). Reports must be an identified validated sample. (IVS)
• HIV
  Evidence of a HIV I and II antibody test (Inc. DNA viral loads if applicable). Reports must be an identified validated sample. (IVS)

A night worker is an employee who is scheduled to work at least 3 hours of his/her daily working time during night-time on the majority of days on which he/she is scheduled to work. Night-time is defined as the period between 11 pm and 6 am.

Night workers are entitled to a health assessment to check whether they are fit for the work to be done. Very few health problems will prevent people being able to work at night, and where there is a medical problem which could be relevant it will almost always be possible for the person to be able to work during night hours with suitable modifications to their treatment programme.

The purpose of the questionnaire is to ask whether you have any health problem which could be affected by night work, so that where necessary an appropriate medical review can be arranged. The questionnaire will be confidential to the Occupational Health Department but a report on your fitness will be provided to your manager who is responsible for work assignments and for the arrangements for health and safety at work.

Please complete this section even if, at the moment, you don't intend to do any night work. This assessment will ensure you are covered in case you take any night work in the future.

UK General Data Protection Regulation (UK GDPR)

All information supplied by you will be held in confidence by Healthier Business UK Ltd. Records will be retained electronically in accordance with best practice and the requirements of the General Data Protection Regulations at which time it may be subject to audit. Your data may also be cross referenced should you have registered with other clients of Healthier Business UK Ltd. Your personal data may be required to be seen by an occupational health advisor or physician; however it will not be shown, nor their contents shared with anyone - including Managers, Human Resources Advisors, GP’s, Specialists or third party’s - without your explicit consent. You have the right of erasure (the right to be forgotten), refusal of consent and withdrawal of consent without detriment (withdrawal of consent can be exercised at any stage of the process). The only exceptions to this may be a court order for release of records in a judicial dispute or where there is a public responsibility obligation. Further information regarding your rights under GDPR can be found on the following:

https://ico.org.uk/for-organisations/guide-to-data-protection/guide-to-the-general-data-protection-regulationgdpr/individual-rights/

If you wish to have sight of our privacy policy, please send your request to support@hbcompliance.co.uk.