
Person to whom it relates has or would have attained the age of 75 years, but in any event for at least 50 years from the date of the last entry. Part A - To be completed by employer (i) Details of employer Name Address (including postcode) (give address at which employee to which this record relates is employed) (ii) Details of employee Surname Forename(s) Permanent address (including postcode) Date of birth Sex Male Female National Insurance No Date of commencement as a classified per.
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How to fill out the F2067 online
The F2067 form is essential for documenting health records related to ionising radiation exposure in the workplace. This guide provides clear, step-by-step instructions to help you complete this important form accurately and efficiently.
Follow the steps to fill out the F2067 online effectively.
- Click ‘Get Form’ button to obtain the F2067 form and access it in the online editor.
- In Part A, begin by entering the employer's details. Fill in the name and address of the employer, ensuring you include the full postcode.
- Next, provide the employee's information by filling in their surname, forename(s), permanent address, date of birth, sex, and National Insurance number.
- Indicate the date when the employee commenced classified employment and describe the nature of their employment.
- For female employees, respond to the question regarding likely exposure to ionising radiation. Specify for each year whether they are expected to receive an equivalent abdominal dose exceeding 13mSv within any three consecutive months by marking 'Yes' or 'No'.
- Fill in the details of the Approved Dosimetry Service responsible for maintaining their dose record, providing the name and address.
- In Part B, the HSE Appointed Doctor or Employment Medical Adviser will complete the assessment details, including the date of assessment, type of assessment, and results.
- Document any conditions or restrictions imposed on the employee as a result of the assessment, and note the expiry date for certification.
- Lastly, the appointed medical professional should provide their name in capitals and professional PIN, followed by their signature.
- Review all entries for accuracy before saving your changes. You can then download, print, or share the completed form as needed.
Begin filling out your F2067 online today to ensure compliance and safety in your workplace.
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