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COUNTY OF LOS ANGELESDepartment of Human Resources Occupational Health Programs PreEmployment/Poster Medical Examinations Phone: 2137382187 Fax: 2137841713PREPLACEMENT HEALTH HISTORY QUESTIONNAIRE

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How to fill out pre-placement health history questionnaire

01

Read the instructions carefully before filling out the pre-placement health history questionnaire.

02

Provide accurate and complete information about your medical history.

03

Answer all the questions honestly and to the best of your knowledge.

04

Include any medications you are currently taking, including dosage and frequency.

05

If you are unsure about any question, consult your healthcare provider for clarification.

06

Submit the completed questionnaire to the designated contact person or department.

Who needs pre-placement health history questionnaire?

01

Individuals who are applying for a pre-placement health examination or assessment as part of the employment process.

02

Employers or companies that require pre-employment health screening to ensure the suitability of candidates for specific job roles.

03

Healthcare providers or occupational health departments involved in evaluating the health status of potential employees.

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