I declare to the best of my knowledge I have answered all the questions above honestly and accurately.
I accept that the answers I have given will be relied upon and that any innacurate or dishonest answers I have given may affect my continued employment.
If I am asked to do so, I agree to discuss my answers and my fitness for work in medical confidence with an Occupational Health professional (either by telephone or face to face), so that professional advice about my fitness for work in this role can be obtained. I understand this would lead to a written report about my capability for this role, but no medical details would be revealed without my consent. This information may be shared with the Health and Safety Manager.