Get Pre Placement Health Assessment Form

Completing the Pre Placement Health Assessment Form is a crucial step in ensuring your suitability for the position you are applying for. This guide provides a clear, step-by-step approach for filling out the form online, allowing you to submit your health information accurately and efficiently.

Follow the steps to complete the Pre Placement Health Assessment Form online.

1. Click ‘Get Form’ button to access the Pre Placement Health Assessment Form and open it in your preferred PDF editor.
2. Begin by entering your last name, first name, and initial at the top of the form. Ensure accuracy as this information is used for identification purposes.
3. Provide your complete address, including city, state, and zip code, along with your hire date and job title.
4. List your emergency contact's name and phone number. This information is essential for your safety and well-being.
5. Indicate your sex and birth date, then provide your phone number and social security number, ensuring that all data is correct.
6. Fill in the name of your family physician and indicate whether you are taking any medications regularly.
7. Document any known allergies by marking 'Yes' or 'No,' and if you answered 'Yes,' list the specific allergies.
8. Review the medical history section carefully. Check any applicable boxes that pertain to your health history, such as vision problems, heart disease, or diabetes.
9. Complete the work health history section by listing any previous exposures to hazardous agents, including details on duration and circumstances.
10. Indicate if you are currently pregnant and provide your due date if applicable.
11. Answer the question regarding recent physician visits and give details if affirmative.
12. Address the hospitalization and surgery section by listing any relevant procedures and dates.
13. Complete the immunization history by providing dates for each vaccination you have received, ensuring to include Hepatitis B, MMR, Varicella, and Tetanus.
14. Finally, read the statement of understanding, sign, and date the form to verify the truthfulness of your responses.
15. Once all fields are completed, you may choose to save changes, download, print, or share the form as needed.

Start completing your Pre Placement Health Assessment Form online today.