Health questionnaire for new employees

Here is a sample health questionnaire that can be used for new employees:

Employee Health Questionnaire

Introduction: As part of our commitment to providing a safe and healthy work environment, we are required to collect certain health information from all new employees. This information will be kept confidential and used only for the purpose of ensuring a safe and healthy work environment.

Section 1: General Health Information

  1. Do you have any pre-existing medical conditions that may affect your ability to perform your job duties? (Yes/No)
  2. Have you ever been diagnosed with a chronic illness or condition? (Yes/No)
  3. Do you have any allergies or sensitivities that may affect your ability to perform your job duties? (Yes/No)
  4. Have you ever had any major surgery or hospitalization? (Yes/No)
  5. Do you have any current medications or treatments that you are taking? (Yes/No)

Section 2: Physical Health

  1. Do you have any physical limitations or disabilities that may affect your ability to perform your job duties? (Yes/No)
  2. Have you ever experienced any of the following: back pain, neck pain, headaches, or other musculoskeletal disorders? (Yes/No)
  3. Do you have any vision or hearing impairments? (Yes/No)
  4. Have you ever had any respiratory problems, such as asthma or COPD? (Yes/No)
  5. Do you have any cardiovascular conditions, such as high blood pressure or heart disease? (Yes/No)

Section 3: Mental Health

  1. Have you ever experienced any of the following: depression, anxiety, or other mental health conditions? (Yes/No)
  2. Do you have any current mental health treatments or medications? (Yes/No)
  3. Have you ever experienced any workplace-related stress or burnout? (Yes/No)
  4. Do you have any concerns about your mental health or well-being? (Yes/No)

Section 4: Vaccinations and Health Screenings

  1. Have you received all recommended vaccinations, including flu shots and COVID-19 vaccinations? (Yes/No)
  2. Have you had any recent health screenings, such as blood work or physical exams? (Yes/No)
  3. Are you up to date on all recommended health screenings and vaccinations? (Yes/No)

Section 5: Additional Information

  1. Is there any additional health information that you would like to share with us? (Open-ended question)
  2. Are there any accommodations or modifications that you may need to perform your job duties? (Yes/No)

Conclusion: Thank you for taking the time to complete this health questionnaire. Please note that all information provided will be kept confidential and used only for the purpose of ensuring a safe and healthy work environment. If you have any questions or concerns, please do not hesitate to reach out to our HR department.

Signature: I, [Employee Name], hereby certify that the information provided in this questionnaire is accurate and complete to the best of my knowledge. I understand that any false or misleading information may result in disciplinary action.

Date: [Date]

Note: This is just a sample questionnaire and may need to be modified to comply with your company's specific policies and procedures. It's also important to ensure that the questionnaire is reviewed and approved by a qualified healthcare professional or HR representative.