Introduction

Dublin City University is committed to the health and safety of its staff. As part of these commitments, this Pre-Employment-Medical-Questionnaire is required to be completed by all staff prior to taking up employment with the University. This form should be returned directly to the Healthy Living Centre for the attention of the Occupational Health Advisor.

The University, like every employer is bound by the Safety, Health and Welfare at Work Act 2005 (General Applications) Regulations 2007, which are supplemented by an Approved Code of Practice. We are required to make assessments of risks to which employees may be exposed at work. A proper risk assessment involves considering not only the nature of the job, but also the fitness of the employee to carry out that work. In addition the Disability Act 2005 imposes a further obligation on the prospective employer to make, where appropriate, reasonable adjustments to enable a suitably qualified candidate to take up proposed employment. This Pre-Employment Health Questionnaire, supplemented where necessary by a further medical assessment, is part of the University’s fulfilment of our legal responsibilities in respect of the above two pieces of legislation.

DCU have contracted the Healthy Living Centre to undertake the assessments on their behalf. The Healthy Living Centre provides a professional and confidential health service and all assessments and interventions are undertaken by an appropriately qualified Occupational Health Advisor.

Confidentiality

The completed form will only be seen by the Occupational Health Advisor.

In the vast majority of cases the questionnaire will be sufficient for the Occupational Health Advisor to confirm medical suitability for employment in the proposed occupation. However, in a very few instances, the Medical Advisor may need to make further enquiry of an individual, or may require a medical examination.

In some instances action may be required by the University to reduce potential risks or to improve the ability of a new member of staff to perform the full duties of the job. Where this requires the disclosure of material facts, e.g. to Human Resources or to the Line Management, such a disclosure will only be made with the informed consent of the prospective employee. In general, therefore, the information given in this form will not be seen by any staff in Human Resources or a University School or Section.

Guidance for Completing the Declaration Form

The position you have recently been offered is subject to satisfactory health clearance from the Occupational Health Advisor at the Healthy Living Centre, DCU.The purpose of pre-employment screening is to ensure that you are well enough for the proposed job and to advise Human Resources on whether you require additional help or support to perform the job if you have a medical condition or disability.

It is essential that you answer all questions fully and give plenty of additional information if you think your health may affect your work, this way we can advise your manager on any reasonable adjustments that may be required. The form will take you approximately 15 – 20 minutes to complete

We respect your confidentiality and comply with the Data Protection Act (1988, 2003) and other relevant legislation. Your form will be assessed by an Occupational Health professional and we assure you that confidential information will not be disclosed to a third party without your express consent. Where we have to examine your personal information for audit purposes, we will not reveal confidential information in any audit report. Specific guidance about the declaration form is given below:

Section 1: Personal Details

Completing all sections will help us identify and link you to the proposed post.  If we have to write to you it will usually be to your home address or e-mail. Note we will not leave voicemail messages or emails that reveal personal confidential information. If we speak to you by telephone we will confirm your identity before asking any personal questions.

Section 2: Declaration for all applicants

As well as filling in your name at the end of this form you will also be required to attend the Healthy Living Centre at DCU after your start date to sign a hard copy of your health declaration. A copy will be available to you at this time. Your signature is required to confirm that you have completed the declaration fully and honestly. Deliberate omissions or misrepresentation may result in your offer being withdrawn or, if appointed, your post being terminated.

Section 3: Declaration of Health

These questions have been designed to allow you and us to assess your health and well-being in relation to the proposed job. We do not require details of health conditions that are not relevant to the job. However, if you have a health condition or disability that may affect your work, you should disclose it fully here. In particular, health problems that may affect work tasks or be affected by work patterns such as night work or working environments should be disclosed and you should give as much information as you can about how this condition affects you in everyday life and at work. Please also give details of any treatment or investigations you may have had or are awaiting and any workplace adjustments that may help or have worked in the past.

Section 4: Immunisations and Blood Tests

If your work involves direct contact with people for the purpose of specimen collection or with hazardous specimens/organisms e.g. laboratory work, you may be at risk of acquiring or transmitting particular infections. We will assess the information you provide with the immunisations required for the post according to national and local policies. If you require additional immunisations or blood tests these can usually be performed when you start but we will contact you if they are required before you may start.

This form should be completed, printed off, signed and returned to the Healthy Living Centre, School of Nursing & Human Sciences, DCU.