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Health Declaration and Immunisation Forms 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information in the designated fields, including your name, student ID, email, and contact number. Ensure all details are accurate for effective communication.
  3. Next, indicate your employment status by selecting the appropriate box. This helps determine your eligibility for vaccination based on your role.
  4. Supervisor/PI must complete the confirmation section regarding vaccination eligibility. They should provide their name, phone number, signature, and date.
  5. As an employee, choose one of the two sections: either request to receive the Hepatitis B vaccine series or decline it. If declining, check applicable reasons and provide a signature with the date.
  6. Finally, review all entries for accuracy before submitting the form via fax or email as instructed at the bottom of the document.

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The Immigration and Nationality Act (INA) requires applicants to submit documentation of having received the following vaccinations: Mumps, measles, rubella; Polio; Tetanus and diphtheria toxoids; Pertussis; Haemophilius influenza type B; and. Hepatitis B.
The medical examination will include a medical history review, physical examination, chest X-ray and blood tests for syphilis. The physical examination will at least include examination of the eyes, ears, nose and throat, extremities, heart, lungs, abdomen, lymph nodes and skin.
Vaccination Requirements Mumps; Measles; Rubella; Polio; Tetanus and Diphtheria Toxoids; Pertussis; Haemophilus influenzae type B; Hepatitis B; and.
I declare that I am not suffering from any infectious, chronic or any other disease, which makes me, unfit. 2. I also declare that I am not suffering from asthma, epilepsy or any other medical problem which requires immediate medical attention.
We use this form to record your declaration regarding your health and any relevant medical conditions. We may also ask you to complete this form to help us determine whether you are suitable to continue in post if there are any docHub changes in your health while registered.

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I further declare that I perform all my routine activities independently, that I do not have any history of, have never suffered from, am not currently suffering from, nor have I received, nor am I currently receiving, nor do I expect to receive any treatment, nor been hospitalized, nor do I expect to be hospitalized

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