4.7 Employee Health Assessment

This form is confidential to occupational health service when completed. 

Please note: All questions must be completed in full. Failure to comply will result in the form being queried and therefore a delay in the assessment being carried out.


give my consent for MOHS Workplace Health Ltd to carry out an employment health assessment. I understand that this is necessary for health and safety reasons and the results of this assessment, including recommendations (but not detailed medical findings) will be given to my employer, to assist in maintaining a healthy and safe workplace. I declare that, to the best of my knowledge, the information given above and in the answers to the health questionnaire is true and complete. I understand that failure to disclose relevant information or providing false information may affect my employment.

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