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Page 1 (3) Document no: 191999 Version: 1.0The worker is to submit this completed and signed form to the doctor, as documentation for the fitness for work certificate. See the attached instructions.
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How to fill out health declaration - work

01
Obtain the health declaration form from your employer or the relevant authority.
02
Begin by filling out your personal information such as your full name, date of birth, and contact details.
03
Provide details about your current employment, including your job title, company name, and work address.
04
Answer the health-related questions accurately and truthfully. These questions may pertain to your recent travel history, exposure to COVID-19, symptoms experienced, and any pre-existing medical conditions.
05
Declare any recent contact with individuals who have tested positive for COVID-19.
06
Sign and date the health declaration form to confirm the accuracy and completeness of the information provided.
07
Submit the completed health declaration form to your employer or the relevant authority as instructed.

Who needs health declaration - work?

01
Anyone who works and is required to attend a workplace needs to fill out a health declaration form. This includes employees, contractors, and anyone else who may enter the work premises. It is a precautionary measure to ensure the safety and wellbeing of all individuals in the work environment.
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A health declaration for work is a formal statement submitted by employees indicating their current health status and any related medical history that may affect their ability to perform job duties.
Typically, all employees, including new hires and those returning to work after a significant absence, are required to file a health declaration, as well as contractors and visitors in certain industries.
To fill out a health declaration for work, employees should complete a designated form that usually includes questions regarding medical history, current health conditions, and any symptoms related to infectious diseases.
The purpose of a health declaration for work is to ensure workplace safety by identifying potential health risks, preventing the spread of illness, and complying with legal and organizational health regulations.
Employees must report their recent travel history, vaccination status, symptoms, and any known exposure to contagious diseases as well as any pre-existing medical conditions that could impact their work.
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