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Undertaking declaration form

Appendix 6 undertaking declaration form 2026

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The document outlines the procedures for occupational assessment, screening, and vaccination against specified infectious diseases for new recruits, clinical personnel, students, volunteers, and facilitators in NSW Health. It mandates the completion of specific forms and submission of vaccination records and serological evidence before commencing employment or clinical placements. Failure to comply may result in suspension from duties. The document also includes a declaration section for individuals to confirm their understanding and compliance with health requirements.

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Click ‘Get Form’ to open the appendix 6 undertaking declaration form in the editor.
Begin by reading the requirements outlined in the form. This ensures you understand the obligations regarding assessment, screening, and vaccination.
In Part 1, select your consent option regarding participation in the assessment process. Choose between confirming no personal circumstances that would prevent you from completing the requirements or indicating any medical contraindications.
Proceed to Part 2 where you will provide evidence of protection for hepatitis B. Select the appropriate option based on your vaccination history and serology results.
In Part 3, acknowledge that you understand the risks associated with infections and agree to comply with protective measures as required by your health service.
Finally, complete the declaration section by filling in your full name, date of birth, worker/student ID (if available), email address, and signature before submitting the form.

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2021	4.8 Satisfied (63 Votes)
2018	4.3 Satisfied (32 Votes)

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What is undertaking declaration form?

A letter of undertaking or undertaking letter is a formal document where one party provides assurance to another that he/she has fulfilled or will fulfill an obligation or requirement under law.

What is the NSW Health service?

Who we are. The NSW public health system is the largest public health system in Australia. NSW Health delivers safe, high-quality and compassionate healthcare to the people of NSW.

Who is the NSW Health Agency education provider?

Health Education and Training Institute (HETI) Health Education and Training Institute is a Chief Executive-governed statutory health corporation which coordinates education and training for NSW Health staff.

What is NSW Health Agency Education Provider?

The Health Education and Training Institute (HETI) is a leading provider of high quality training and education to support more than 110,000 clinical and non-clinical staff, trainers, managers and leaders across the NSW health system.

What is NSW in healthcare?

The New South Wales Ministry of Health, branded NSW Health, is a ministerial department of the New South Wales Government. NSW Health supports the executive and statutory roles of the Ministers for Health, Regional Health, Mental Health, and Medical Research.

appendix 6 undertaking declaration form

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What is the medical declaration form?

A medical declaration is used by organizations if they want to ascertain the health status of their employee or participant, It can also be used before a person travels to a particular state or country. It contains questions about the persons health status and medical history.

What does NSW stand for in healthcare?

NSW Health means public health organisations, the Public Health System Support Division, the Ambulance Service of New South Wales and the Department of Health.