Health Declaration

Health Declaration

Occupational Health Declaration Form

This health screening is undertaken in order to limit the risk of your health being detrimentally affected by your work and to ensure you are fit to undertake the duties of the roles for which you have applied. This information is assessed by Medacs Doctors' Occupational Health Department, and only the staff working in that department will have access to this information.


Medacs Doctors' Occupational Health Professionals will provide your Placement Officer with a Certificate of Fitness which will confirm your fitness to undertake the duties required and also contain details of your immunity status. Medacs Doctors' Placement Officers may disclose this certificate to clients for the purpose of finding you suitable assignments.

Information contained within this Occupational Health Declaration Form is governed by the Data Protection Act 1998.


You may be contacted by the Occupational Health Professionals for further information or be asked to attend a medical examination. The Occupational Health Department will not communicate with any other health professional (such as GP or any other Occupational Health Department) or disclose the information on this form without you providing separate written consent. Please ensure this form is completed fully and accurately.