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Online Night Workers Health Assessment Questionnaire

The Working Time Regulations 1998 Health Assessment Questionnaire - Night Workers

A night worker is an employee who is scheduled to work at least 3 hours of his/her daily working time during night time on the majority of days on which he/she is scheduled to work.   Night time is defined as the period between 11 pm and 6 am.

Night workers are entitled to a voluntary health assessment to check whether they are fit for the work to be done.  Very few health problems will prevent people being able to work at night, and where there is a medical problem which could be relevant it will almost always be possible for the person to be able to work during night hours with suitable modifications to their treatment programme. 

The purpose of the questionnaire is to ask whether you have any health problem which could be affected by night work, so that where necessary an appropriate medical review can be arranged.  The questionnaire will be confidential to the Occupational Health Department but a report on your fitness will be provided to your manager who is responsible for work assignments and for the arrangements for health and safety at work.

Shea Occupational Health is committed to upholding the security of your data. We use industry standard security technology and practices to safeguard your data from any unauthorised access, so that you can be confident in using our service. We have prepared some information on the security of your personal data whilst using our online forms which you can view by clicking the link below. 

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Before you complete the referral

The questions that we ask you on this page helps us to check that your company has obtained permission from us to use this online referral form after accepting our terms of business and signing up to use this service.

After completing this page and entering a valid username and password, we will take the contact details for the employee you would like to refer to us and your details for us to provide the occupational health report.

Your recruiting company is not currently recognised as one that uses our occupational health services. If they would like to sign up to use this service, please contact us.

1. You are identified as a night worker as defined by the Working time directive?

You will not be eligible to complete the attached health questionnaire.

2. Your company have offered you a voluntary night worker health assessment and referral to occupational health?

You are not eligible to complete the attached health questionnaire as your employer has not offered you the assessment.

3. You confirm that it is in your best interest, as well as that of the company that this form is completed accurately and to the best of your knowledge?

If you do not confirm, you may well be employed on work for which your health makes you unsuitable which may have serious consequences to you or the company. Any proven falsification of this form may be the subject of withdrawal of the offer of employment from the recruiting company, if employment has not yet commenced, or disciplinary action and dismissal if employment has commenced.

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