Get Health Surveillance Form

Completing the Health Surveillance Form online is a straightforward process that ensures accurate health monitoring for individuals exposed to workplace hazards. This guide provides clear, step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the Health Surveillance Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the appropriate editor.
2. Begin by entering your personal details, including your full name, current address, National Insurance number, and date of birth.
3. Fill in your employer's information by providing their name and address to establish your workplace context.
4. Indicate the specific work activity you are engaged in and ensure that the Form FODMS75 is completed and attached.
5. Outline your occupational history by checking the relevant box to indicate whether the health surveillance record from prior work is completed.
6. Complete the respiratory symptom questionnaire by checking the appropriate box to confirm it has been filled out.
7. Input your medical history, including smoking status, any respiratory conditions, and any other relevant medical information.
8. Record the results of your clinical examination, including any spirometry results such as FEV1 and FVC values, as well as any noted conditions like finger clubbing.
9. After the examination, indicate the chest X-ray results and summarize the findings, ensuring to justify any abnormalities on clinical grounds.
10. Provide advice given to the employee regarding their fitness for work related to asbestos or enclosures, checking the box as applicable.
11. Confirm whether the individual is likely fit to work in enclosures by selecting either 'Yes' or 'No'.
12. Document the date of the next review, typically set for two years unless otherwise specified.
13. Sign the form to certify that the information provided is accurate and complete.
14. Once completed, ensure to save any changes made, and then proceed to download, print, or share the form as needed.

Fill out your Health Surveillance Form online today to ensure you are maintaining a safe working environment.