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The document is a Health Surveillance Questionnaire from Ottobock Healthcare PLC, designed to gather information from employees during the induction process and annually thereafter. It aims to identify any health issues that may affect workplace safety and support, particularly in roles requiring mandatory health surveillance. The questionnaire includes various health-related questions and requires employee signatures.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the designated fields: Name, Date of Birth, Job Title, Branch, Department/Area, and Start Date.
For the health-related questions, read each item carefully. Select 'Yes' or 'No' for any health issues experienced in the past 12 months.
If you answered 'Yes' to any question, provide detailed information in the space provided to ensure comprehensive support.
In the section regarding remedial measures, outline any additional requirements as discussed with your Line Manager or Health & Safety Representative.
Finally, sign and date the form at the bottom to confirm that all information is accurate and complete.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (260 Votes)

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Create electronic pdf form 2026

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How to use or fill out create electronic pdf form