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Medical declaration form template

Reviewed 1 June 2021

You may wish for new employees (including those changing roles) to complete a medical declaration form prior to commencing employment. This process enables new starters to declare any health condition or disability which may affect their ability to do the job they have been offered. The form may be used in order to accommodate any disability or impairment which a candidate has declared.

Adjustments may include physical adaptations, or adjustments to working arrangements such as hours. Where the candidate has answers ‘Yes’ to any of the questions in the declaration, you might want to also involve an Occupational Health Service (OHS) who may provide further advice.

Medical declaration

If you have a physical / mental impairment which has a substantial and long term effect on your ability to carry out day to day activities, please specify any special arrangements for work associated with any impairment:  
Please list any diseases, disorders, alle

This is a word-limited preview. The full template will be displayed here in full once you purchase it individually, or when you purchase the management template pack.

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Unlimited downloads of this Medical declaration form template, all other Health and Safety templates, AND everything else in the Management template pack for 12 months.

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