Health Surveillance Questionnaire Form Template

Form Health Surveillance Questionnaire image 1
(£6.00 inc.VAT)


  • Instant access
  • 4 pages
  • Online editor
  • Your business name
  • Edit for 30 days
  • PDF download


  • 665+ documents
  • Individual plans
  • Team plans
  • Your business logo
  • Unlimited edits
  • Fully branded

Document Description

Create your document in minutes with this ready to use Health Surveillance Questionnaire Form template. Use the quick and easy editor to add your details, make changes, and download a completed document branded with your business name.

This Health Surveillance Questionnaire Form can be used to gather health information from your employees so you can take action to prevent the development of health problems.

If your workers are exposed to work activities that are associated with health risks then suitable health surveillance should be in place.

The health surveillance process involves collecting information about workers health, and using this information to prevent development of health problems by detecting early warning signs.

This Health Surveillance Questionnaire Form covers a variety of health issues arising from noise exposure, hand-arm vibration exposure, skin issues and respiratory issues.

The Health Surveillance Questionnaire Form is a simple questionnaire based on self examination and reporting by the employee, this is suitable surveillance for the majority of employees. However, don't forget you may need to go further than this, for example skin screening or respiratory testing, depending on the hazards your employees are exposed to at work. If in doubt consult an occupational health professional.

You can use the Health Surveillance Questionnaire Form template as it is, in your business, and we will add your business name at the top of each page. The template is ready for you to fill in and complete, you can edit it as much as you need to produce a site specific health and safety document for your projects or workplace.


This 4 page document includes:

How do I edit this document?

This Health Surveillance Questionnaire Form template can be edited online within your browser. Editing is quick and simple, but if you need more time, there's no hurry to finish your document today - you get 30 days use of the template and online editor to create your document.

When you complete your order, the document can be found in your account under 'Documents'. You can edit the document online from your HASpod account.

How do I download this document?

Download in PDF format for maximum compatibility across devices - no special software required. Once downloaded you can save, print and use your Health Surveillance Questionnaire Form document within your business for as long as you need it.

After making your edits, click the download button to get your PDF - we will add your business name in the header for you.

Get unlimited access to every document on the Documents Plan.