Your Search Registration
Part 2
Please select and complete the Medical declaration as well as any section(s) below that are relevant to the type of work you are looking for.
Once you have completed all that are relevant you may leave the page.
Please select and complete any section(s) below that are relevant to the type of work you are looking for.
Once you have completed all that are relevant you may leave the page.
OCCUPATIONAL HEALTH MEDICAL QUESTIONNAIRE
CONFIDENTIAL
Due to the nature of the role you have applied for we need to carry out a complete a new starter health questionnaire – even if you have been employed in UK health services before. The health of each candidate is considered individually and a decision regarding fitness for work in the prospective job role will be based on the functional effects of any underlying health condition/disability/impairment as well as health service requirements for fitness and immune status.
Before health clearance is given for employment you may be contacted by telephone from a clinician at Healthier Business UK Ltd, however you may also need to be seen by an occupational health advisor/specialist or physician, arrangements for face to face consultations will be arranged by your employer or agency. We may recommend adjustments or assistance following an assessment to enable you to carry out your proposed duties safely and effectively. Recommendations to your employer will be directed to essential information regarding your health and the hazards and risks of your employment and with due reference to other relevant statutory requirements and professional practice. Our aim is to promote and maintain the health of all individuals in the workplace: staff, service users and third parties. Your records will be retained electronically in accordance with best practice and the requirements of the General Data Protection Regulations. Your records will be held on file for the purposes of processing your request only and for no longer than is necessary, however your records may be subject to internal clinical audits. Your records may also be used to cross reference and ascertain your fitness should you register with other clients of Healthier Business UK Ltd.
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EC Drivers' Hours Regulation
If you are applying for a Driving role, please complete the questions below:
1.
The time is now 10.00 and you have been driving without taking a break of any kind since 06.00. Under EC rules how long may you drive before taking a break? *
2.
Under EU Drivers Rules when taking a break of 45 minutes how can the break be divided? *
3.
In a week the daily driving period must not exceed? *
4.
How many times in a week can the daily driving period be extended? *
5.
How much can the daily driving period be extended to a certain number of times a week? *
6.
What is the minimum weekly rest period that must be taken? *
7.
How much can the weekly rest period be reduced to in certain cases? *
8.
What is the maximum driving period in a fortnight (2 consecutive weeks)? *
9.
What is the minimum daily rest period? *
10.
How often in a week can the minimum daily rest period be reduced? *
11.
When using an analogue tachograph how many unused charts should you carry whilst on duty? *
12.
When using a digital tachograph what is the maximum number of days that data can be stored on the digital tachograph card before it must be downloaded? *
13.
If a digital tachograph card cannot be used (for example because it has been lost or stolen) how long can the driver drive without a card provided that a print out at the start of the day and the end of the day and there is no change of vehicle? *
14.
If the driver has lost their digital tachograph card or it has been stolen within what period of time must the driver apply to DVLA for a new card? *
15.
What do the following symbols indicate? *
a)
b)
c)
d)
Drivers' LGV General
1.
What is the minimum height of an unmarked bridge? *
2.
You are driving a lorry with a maximum authorised mass of more than 7.5 tonnes, what is the national speed limit on a dual carriageway? *
3.
What can reduce Brake Fade when driving down a long hill? *
4.
When the brake air pressure warning light is operating you should NEVER? *
5.
Which of the following is most likely to cause a burst tyre when driving? *
6.
You should not use a mobile phone when driving? *
7.
What is the minimum depth of tread required over three quarters of the breadth of a vehicle with a weight above 7.5T tyre? *
Chef
If you are applying for a Chef role please complete the questions below.
How long have you worked as a Chef? *
Years
Months
Please list your qualifications *
Please list the sections of the Kitchen in which you have worked *
Please indicate if you have experience in the following:
Ordering Stock
Budgeting
Menu Developments
Menu Costings
HACCP Recording
Other, please specify
Please give details of the type of kitchen machinery you have used? *
Please give details of any special function experience? *
What is the range of covers you have catered for? *
What is the range of staff you have worked alongside in the kitchen? *
What levels of chef assignments are you willing to accept? *
Do you have your own knives and whites? *
Bar / Waiter
If you are applying for a Front of House role please complete the questions below.
Do you have experience cashing up? *
Do you have experience supervising or managing staff? *
How would you check the validity of a note? *
What are the correct measures in which wine should be served? *
When should you ID a customer? *
Please list what till operating systems you have previously worked with? *
What is the correct measure by which spirits should be served? *
What side should you serve food from? *
What side should you clear food from? *
If you were laying up a table setting does the fork go on the left or right? *
How many starter plates can you carry to the table? *
Safe Manual Handling Declaration
A.
Start with load between your feet (diagram 1 & 2)
B.
Get down to the level of the load – bend your knees and hips. Keep your back straight from head to tail (diagram 3)
C.
Get a firm grip on the load (diagram 4)
D.
Stand up in one smooth movement, looking ahead to help keep your back straight. Keep the load close to your body - do not jerk (diagram 5, 6, 7, 8 & 9)
E.
Reverse the above procedure to lower the load. Keep your back straight and bend your knees and hips
POINTS TO REMEMBER
- Do not carry more than approximately 25kg by yourself
- Use teamwork if the weight is more that 25kg
- Remove any obstructions in your path
- Keep loads close to your body
- Do not twist or turn while lifting or carrying
- Wear all available personal protective equipment
Declaration:
By ticking this statement I hereby declare that I have read, understood and will adhere to the above Safe Manual Handling guidance at all times whilst on assignment. *
Safe Manual Handling
Please complete the following section on Manual Handling.
1.
Who is responsible for Health and Safety at work? *
2.
Which of the following activities are classed as Manual Handling? *
3.
What you understand to be LOAD? *
4.
What you should do before moving a load? *
5.
Which of the following actions should you take if weight is too heavy or size is too big for your capabilities? *
6.
What are the 3 main points to remember when lifting from a lower level? *
a)
b)
c)
7.
Which of the following should you NOT do when manual handling? *
8.
If you have any concerns about something in the workplace being unsafe, who would you speak to? *
9.
In the event of having an accident, when should the details be recorded? *
Warehouse Knowledge
If you are applying for a Warehouse role please complete the questions below.
1.
Re-arrange the numbers into numerical order (lowest first): *
82, 28, 33, 4, 5, 29, 1, 83
2.
Re-arrange the letters into alphabetical order: *
Q, N, B, O, C, S, T
3.
Choose the correct answer to fill the gap: *
Simon…….very tall
4.
Choose the correct answer to fill the gap: *
Tim…….work in the morning
5.
Calculate the following: *
a) 685 + 317 =
b) 163 – 47 =
c) 217 x 3 =
6.
Compare the columns and tick the box if they are the same: *
487 203 1114
487 203 1214
061 764 5747
061 746 7257
409574
409574
5139041117
5139041117
Use the table below to answer questions 7, 8, 9 and 10
7.
What prism corresponds to food? *
8.
How many boxes of prism 131511102 are required? *
9.
Which pin number is incorrect? *
10.
Where is the location for prism code 0901/112/01? *
FLT (Forklift Truck)
If you are applying for a FLT role please complete the questions below.
Part 1
1.
What is the recommended way to approach a stack to place or retrieve a load? *
2.
In normal circumstances, if the load in the fork arms obscures your view, you should :- *
3.
When tilting a load forward at height, why is there an increased risk of the truck tipping? *
4.
When operating a lift truck what would you do if you saw some rubbish/dunnage lying in a gangway or warehouse location? *
5.
When travelling on slopes where should the load be carried on the fork arms? *
Part 2
1.
Who is responsible for carrying out pre-shift checks immediately prior to use? *
2.
The trucks rated capacity will be reduced when: *
3.
The lift truck’s rated capacity applies when the mast is in the: *
4.
When driving an unladen truck how should the fork arms be set? *
5.
Before moving off with a lift truck, what is the last thing the operator must do? *
Food Production
If you are applying for a Food Production role please complete the questions below.
1.
Jewellery should not be worn in food production area because it: *
2.
Overall or over clothes worn by people who handle food must be: *
3.
Why should you always wash your hands at work? *
4.
When you put food in the fridge, what happens to bacteria? *
5.
You have been making a pudding and have half a tin of fruit slices left over. How should you put the fruit in the fridge in? *
6.
If food is kept hot before serving, what is the lowest temperature it must be kept above? *
7.
There are 4 containers of cream in the fridge. You should use the one with the ‘best by’ date which is: *
8.
After an absence with an upset stomach, you are able to go back to work: *
9.
When should you wash your hands? *
(1) After any break period
(2) When you have cut up some raw food
(3) When you have put some sausage rolls on
(4) When you empty the waste bin
10.
Which one of the following must you do when cleaning floors? *
11.
What temperature promotes the growth of food poisoning bacteria? *
12.
You are cooking a piece of meat that will be served cold tomorrow with salad. How should you cool it? *
13.
What is the most common cause of food poisoning? *
14.
A common symptom of food poisoning is: *
15.
High risk foods are: *
Medical Declaration
Please complete the following information:
Name
Address
The information below is required with your interests in mind. As a result of this information you may be referred to a doctor appointed by the company so that a medical examination can be carried out. Completed questionnaires are held and assessed in complete confidence.
Do you suffer from any of the following?
Diabetes *
If Yes, please give details
High Blood Pressure *
If Yes, please give details
Asthma or other respiratory complaints *
If Yes, please give details
Heart or circulatory disorder *
If Yes, please give details
Serious skin complaints *
If Yes, please give details
Alcohol or drug dependency *
If Yes, please give details
Allergies *
If Yes, please give details
Epilepsy/Fits/Blackouts *
If Yes, please give details
Do you have any other conditions or health factors, which might affect you during your assignment(s) with Search, or which may require some reasonable adjustment to be made, in your line of work? *
If Yes, please give details
Night Working
Please complete the following if, during any assignment with Search, you will regularly work for more than three hours during the period 11pm to 6am. This is designed to identify possible areas of special need in relation to Night Work.
Do you suffer from any of the following?
Any condition which causes difficulty sleeping *
If Yes, please give details
A chest disorder, which affects you at night *
If Yes, please give details
Arthritis *
If Yes, please give details
Serious skin complaints *
If Yes, please give details
Epilepsy/Fits/Blackouts *
If Yes, please give details
Any medical condition requiring medication to a strict timetable *
If Yes, please give details
Any other condition or health factors, which might affect your fitness for night work *
If Yes, please give details
To the best of my knowledge and belief the information given above is correct. I understand that, if this information is inaccurate and either (a) if I am offered a position, that offer may be withdrawn or (b) if I am appointed, I may be dismissed. I hereby consent to the Company seeking information from my Doctor who has attended me and I authorise the giving of such information.
Doctor's Name
Doctor's Address
Doctor's Telephone Number
