Health Surveillance Questionnaire Form Template

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.

The template guides you through the key information needed to complete your health surveillance questionnaire form. You'll have 30 days' access to the online template, with the option to download your completed form document as a non-editable PDF to keep, share and use within your business, with your business name displayed in the header of each page.