Useful forms

Immunisation and health surveillance referral

Form: Immunisation and health surveillance referral
Completed by: School or Service Head or SSA
Purpose: For all staff or students requiring immunisation or health surveillance as part of their work or course.

Night workers health questionnaire

Form: Night workers health questionnaire
Completed by: Employee
Purpose: To identify possible areas of special need in relation to night work.

Pre-course health questionnaire

Form: Pre-course health questionnaire
Completed by: Prospective students who plan to study Faculty of Health courses
Purpose: Health screening before you start your course

You will be sent your pre-course health questionnaire by the Admissions team. Once completed, submit the form using the Admissions portal.

Research passport health questionnaire

Form: Research passport health questionnaire
Completed by: Faculty, School or Department representative
Purpose: Confidential health assessment to ensure you are fit for the research activities you will be undertaking within the NHS in order to protect your own health and safety, and that of others.

Research referral

Form: Research referral
Completed by: School or Service Head or SSA 
Purpose: Confidential health assessment to ensure you are fit for the research activities you will be undertaking and/or that requirements for disability support can be assessed. For example:

  • a worker will be using hazard group 3 biological agents or working in a CL-3 facility, required before undertaking such work and also if their health status changes,
  • an activity risk assessment identifies a requirement for an occupational health assessment before a substance hazardous to health is used or before working in an area where it is used,
  • the health status of a current worker changes so they are at increased risk from accidental exposure to a substance hazardous to health used by them or in their workplace, as identified in an activity risk assessment,
  • disability or health support may be required when undertaking research work.

Workspace setup (DSE)

Form: Workstation risk assessment
Completed by: Staff member with contribution from local DSE assessor
Purpose: Assess the risk of workstation setup and make ergonomic adjustments where needed.

Work-related stress

Form: Work-related stress risk assessment
Completed by: Management
Purpose: Identify the risk factors for work-related stress and create an action plan to address these.

Work-related travel immunisation referral

Form: Work-related travel immunisation referral
Completed by: School or Service Head or SSA
Purpose: Protection for all staff or students who require immunisations for travel abroad as part of their work or course.

Travel vaccination schedules need advanced planning because sufficient time is needed for any vaccine to be effective and for vaccination courses to be completed.

Contact us

If you have difficulty completing a form or wish to discuss any issues in a confidential setting, contact us for advice.

Forms

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