Get the free Medical Surveillance Form - HSE

Health and Safety ExecutiveMedical Surveillance Form Licensed Work Guidance on completion of the consent section (page 1 of the MS75) An MS75 form should be completed for every medical examination

How to fill out medical surveillance form

How to fill out medical surveillance form

1. Step 1: Start by gathering all the necessary information required for the medical surveillance form.
2. Step 2: Read the instructions provided on the form carefully to understand the specific requirements and guidelines.
3. Step 3: Begin filling out the form by entering your personal details such as your full name, date of birth, contact information, and address.
4. Step 4: Proceed to provide information about your medical history, including any pre-existing conditions, allergies, surgeries, and medication that you are currently taking.
5. Step 5: If applicable, provide information about your occupational history, including details of your current or previous job, job title, and any hazardous substances or activities you may have been exposed to.
6. Step 6: Answer any additional questions or sections on the form related to specific health concerns or conditions that need to be monitored or evaluated.
7. Step 7: Review the completed form for any errors or omissions before submitting it.
8. Step 8: Finally, sign and date the form to certify the accuracy and completeness of the information provided.
9. Step 9: Submit the form as per the instructions provided, whether it is to be handed over to a healthcare professional, mailed, or uploaded through an online portal.

Who needs medical surveillance form?

1. Medical surveillance forms are typically required for individuals who are involved in certain occupations or workplaces where there may be potential health risks or exposure to hazardous substances.
2. This includes industries such as construction, manufacturing, mining, healthcare, agriculture, and laboratories.
3. Employers may also require their employees to undergo medical surveillance as part of workplace safety protocols.
4. Additionally, individuals who are applying for certain licenses or permits, such as commercial driver's licenses or aviation licenses, may also be required to complete medical surveillance forms.

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What is medical surveillance form?

The medical surveillance form is a document used to track and monitor the health status of individuals who may have been exposed to hazardous substances or working conditions.

Who is required to file medical surveillance form?

Employers are typically required to file the medical surveillance form for their employees, especially in industries where there is a risk of exposure to harmful substances or conditions.

How to fill out medical surveillance form?

The medical surveillance form usually requires detailed information about the individual's medical history, exposure to hazards, and results of any medical tests or examinations.

What is the purpose of medical surveillance form?

The purpose of the medical surveillance form is to ensure that individuals are being monitored for any potential health issues related to their work environment, and to take appropriate actions to protect their health and safety.

What information must be reported on medical surveillance form?

The medical surveillance form typically requires information such as the individual's name, medical history, exposure to hazards, results of medical tests, and any recommended follow-up actions.