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Occupational Health Service REQUEST FOR HEALTH SURVEILLANCE Please complete the following for staff and postgraduates who have commenced work and will require health surveillance as indicated by an

How to fill out request for health surveillance

How to fill out a request for health surveillance:

1. Start by obtaining the necessary form for requesting health surveillance. This can usually be obtained from your employer or the relevant health and safety department.
2. Fill out the personal information section of the form, including your full name, contact details, and any other requested information. Make sure to provide accurate and up-to-date information.
3. Next, provide details about your job position and the nature of your work. This could include the specific tasks you perform, any potential hazards or risks associated with your job, and the duration of your employment.
4. Indicate the reason for requesting health surveillance. This could be due to exposure to certain substances or hazards in the workplace or because it is a regulatory requirement for your industry. Be specific and provide any relevant details or supporting documentation.
5. If you have any pre-existing health conditions or concerns, make sure to mention them in the appropriate section of the form. This information will help healthcare professionals to monitor and evaluate your health more effectively.
6. If required, provide a brief medical history, including any relevant tests or examinations you have undergone in the past. This information will assist healthcare professionals in identifying potential health issues or changes.
7. Finally, sign and date the request form. Ensure that you have read and understood the consent and privacy statements, and acknowledge that you are authorizing the collection and use of your health information for surveillance purposes.

Who needs a request for health surveillance?

1. Employees working in certain industries or environments where there is a risk of exposure to hazardous substances, pollutants, or other workplace hazards may require health surveillance.
2. Specific regulations and guidelines may outline the need for health surveillance in industries such as construction, mining, manufacturing, healthcare, and laboratories.
3. Employers may also request health surveillance for employees who work with hazardous materials, undergo certain job-specific medical examinations, or are required to meet regulatory compliance.

In conclusion, filling out a request for health surveillance involves providing personal information, job-related details, mentioning the reason for the request, disclosing any pre-existing health conditions, and signing the consent form. This process helps employers and healthcare professionals monitor and protect the health of employees in high-risk or regulated environments.

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