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Health screening questionnaire pdf 2025

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The document is a Health Screening Questionnaire (HSQ) designed by the USDA Forest Service and Department of the Interior to assess the health needs of individuals before they take the Work Capacity Test (WCT). It includes a series of yes/no questions aimed at identifying potential health risks related to physical activity. The HSQ is not a medical examination, but it requires individuals with certain health concerns to consult their personal physician before participating in the WCT. Additionally, it contains privacy and paperwork reduction statements.

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Click ‘Get Form’ to open the health screening questionnaire in the editor.
Begin by selecting your Work Capacity Test (WCT) level: Arduous, Moderate, or Light. This helps assess your physical readiness.
Proceed to answer each question by checking 'Yes' or 'No'. These questions are designed to identify any potential health risks related to the WCT.
If you answer 'Yes' to any question, note that a determination from your personal physician is required before participating in the WCT.
Complete the signature section at the end of the form, including your printed name, date, unit, city, and state.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (142 Votes)
2013	4.7 Satisfied (48 Votes)
2009	4 Satisfied (21 Votes)

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What is a health check questionnaire?

The Health Check Questionnaire is used to help gather data on a patients general health. Using the information gathered, clinicians can determine the most helpful subsequent steps e.g. video call.

What questions are on the health questionnaire?

What are the best health survey questions? How healthy would you consider yourself on a scale of 1-10? Does your family have any history of hereditary disease? Do you have any chronic diseases? Do you take any drugs? Do you drink alcohol? Do you smoke? How often do you do a health check-up?

What does the patient health questionnaire indicate?

The Health Assessment Questionnaire is a survey designed to gather information about an individuals health status. The survey consists of four sections, including personal information, lifestyle, medical history, and mental health.

What does a health screening test consist of?

Health professionals often think of screening for early diagnosis of cancer (such as Pap smears for cervical cancer or colonoscopy for colon cancer), but there are many other screening tests commonly used, for example, thyroid-stimulating hormone (TSH) for congenital hypothyroidism in newborns, cholesterol level for

What is the 9 item patient health questionnaire?

The PHQ-9 (Appendix) is the 9-item depression module from the full PHQ. Major depression is diagnosed if 5 or more of the 9 depressive symptom criteria have been present at least more than half the days in the past 2 weeks, and 1 of the symptoms is depressed mood or anhedonia.

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What is a health assessment questionnaire?

The Patient Health Questionnaire (PHQ) is a new instrument for making criteria-based diagnoses of depressive and other mental disorders commonly encountered in primary care.

Health screening questionnaire pdf 2025

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