Think Teachers Pre-Employment Health Questionnaire

Purpose of this form

Think Teachers collects this information to help us meet our duty of care, ensure a safe working environment, and make reasonable adjustments if required.
All information is strictly confidential and processed under the Data Protection Act 2018 and UK GDPR.

Candidate Details

Name

First NameLast Name

Today's Date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth

Date

Phone Number

Area CodePhone Number

Email

example@example.com

Role Applied For

Name of GP

GP Telephone Number

Please enter a valid phone number.Format: (000) 000-0000.

GP Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Section 1 – Health History

Please tick YES or NO and provide details if applicable.

Rows	YES	NO
Visual or eye conditions (including colour vision)
Hearing or balance problems
Mental health concerns (e.g. anxiety, depression
Neurological conditions (e.g. epilepsy, migraines, fainting)
Heart, circulation, or blood pressure problems
Respiratory conditions (e.g. asthma, bronchitis, TB)
Digestive or bowel disorders
Liver, kidney, or bladder problems
Musculoskeletal issues (e.g. back pain, arthritis)
Skin conditions (e.g. eczema, dermatitis)
Diabetes, thyroid, or hormonal disorders
Allergies or intolerances (e.g. food, medication, animals)
Immune system disorders or recurrent infections
Disability, long-term condition, or mobility limitation
Alcohol or substance-related illness
Any other condition or treatment not listed above

Section 2 – Recent Health

Question

Rows	YES	NO
Any other condition or treatment not listed above
Are you currently under medical care or treatment?
Are you taking any prescribed medication?
Have you had more than 20 days sickness absence in the past 2 years?
Have you ever been admitted to hospital or had surgery?
Do you have any condition that may affect your ability to work with children?

Section 3 – Support & Adjustments

If you have a health condition or disability, pleaseindicate if you may require adjustments during assignments (e.g. accessibility,workload, equipment).We will use this information only to support you — not toassess suitability.

Section 4 – Declaration & Consent

I confirm that the information provided is true and complete to the best of my knowledge. I understand that giving false or incomplete information may result in thewithdrawal of work opportunities or my registration with Think Teachers. I understand that I have a continuing duty to inform Think Teachers immediately if my health changes in a way that may affect my ability to carry out assignments safely or may require reasonable adjustments. I consent to:

Signature

Date Completed: