Pets-Choice-Induction - Major Recruitment

Name *

First

Last

Email *

Phone

Do you have any current physical or mental health conditions or disabilities that would affect your ability to perform this role? *

Do you require an adjustment or adaptation to the work, work equipment or workplace to enable you to do your job? *

Do you have, or have you ever had, any health problems that may have been caused, or might be made worse, by your work? *

Are you undergoing or waiting for any medical treatment or investigation, or taking any medication? *

Do you have any hearing problems not corrected with a hearing aid? *

Do you have any Allergies / Anaphylactic shock risk? *

Have you ever had Asthma / bronchitis or chest problems that require routine inhaler use / inhalers to be carried on your person? *

Do you have any difficulty in standing, bending, lifting or other movements? *

Do you or have you ever had Epilepsy / history of seizures / Heart conditions / Diabetes? *

Do you or have you ever had a Stoke / history of TIA / Vasavagal episodes? *

Do you require to use/ have any other medications (insulin/ epi pens/ other inhalers/ GTN spray and such) during working hours? *

If you have Selected Yes to any of the above questions, please provide more information