The purpose of this pre-employment questionnaire is to

• Establish that you are medically fit for the job you have applied for

• Establish that you are able to give regular and effective service

• Establish that you can carry out the job without any undue risk to the health and safety of yourself and others

• Establish a baseline for future occupational health records

• Establish if any workplace modifications or adjustments are required due to a disability

It is important you answer the questions as clearly and as accurately as possible, giving details for any ‘yes’ answers. The occupational health department may need further information to make an informed decision on your ability to do the job. This may involve contacting you and or your doctor by telephone (if you have given permission for this), seeking a report from your family doctor or hospital specialist, or making an appointment for you to be reviewed by an Occupational Health Nurse and / or Occupational Health Doctor at the Civil Service Occupational Health Department in Dublin.

Data Protection Notice

The completed questionnaire with be stored in either electronic or paper form by the Civil Service Occupational Health Department in accordance with the Data Protection Legislation. The medical information supplied will be treated in strict confidence and will not be disclosed to any third party without your consent. Any advice given to the employing department / authority and / or personnel / human resources will be in general terms only. Information gathered may be disclosed on an anonymous basis in a group format for research purposes. This record may be accessed by you under data protection legislation.

Thank you for giving this questionnaire your time and attention.

Please click here to go to the Questionnaire.