FIT4JOBS - The Employment Health Screening Service

Questionnaire Answers

Question	Answer	Score	Critical
Medical History
Have you ever suffered from skin problems?	No	5	No
Have you ever suffered from kidney or bladder problems?	No	8	No
Have you ever suffered from stomach problems?	No	9	No
Do you suffer from any circulation problems e.g. Varicose veins, Raynauds disease?	No	7	No
Do you suffer from any blood disorders?	No	6	No
Have you ever suffered from epilepsy?	No	12	No
Have you ever suffered from or been diagnosed with high blood pressure?	No	6	No
Have you ever suffered from any heart disease/problems?	No	6	No
Have you ever suffered from any mental health conditions e.g. Anxiety/Depression/Stress?	No	8	No
Have you ever suffered from painful joints?	No	8	No
Have you ever suffered from or been treated for a rupture or hernia?	No	8	No
Have you ever suffered from migraine or persistent headaches?	No	10	No
Do you you have any allergies?	No	4	No
Have you been diagnosed with an immune disorder?	No	2	No
Have you ever broken a bone in your body?	No	6	No
Do you have diabetes?	No	12	No
Do you have any current or past visual impairment (exclude wearing glasses or contact lenses)?	No	12	No
Have you ever suffered from neck or back pain?	No	10	No
Do you have poor hearing in either ear?	No	6	No
Have you ever suffered from asthma?	No	6	No
Are you currently taking any medication not previously noted?	Yes	1	No
Please provide further details	Contraceptive pill
Are you currently receiving any medical treatment?	No	2	No
Have you suffered from or do you suffer from any significant health condition that effects your overall wellbeing or functional ability?	No	1	No
Have you ever been off work for more than 2 weeks due to a health or medical reason?	No	6	No
Have you ever been referred to a specialist medical consultant?	No	6	No
Have you ever been admitted to a hospital for longer than 24 hours?	No	2	No
Have you been tested for Covid-19?	Yes	0	No
When were you tested?	15/01/2022
What was the test result?	Negative	1	No
Do you currently have any symptoms of Covid-19?	No	1	No
Do you have or have you had in the past 7 days any of the following - a high temperature?	No	1	No
or a new or continuous cough?	No	1	No
or have you felt breathless more than you usually feel?	No	1	No
or have you had any signs of shock?	No	1	No
or have you started to feel confused more than normal?	No	1	No
or have you experienced a loss of taste or smell?	No	1	No
Have you been informed by your doctor that you should take shielded measures to protect you from Covid-19 infection?	No	1	No
Are you currently self-isolating?	No	1	No
Have you been in close contact with an infected person in the last 14 days?	No	1	No
Are you a Healthcare Worker?	Yes	0	No
Are you or do you live with a Vulnerable person?	No	1	No
Have you had a bone marrow or stem cell transplant in the past 6 months?	No	1	No
Do you have any severe respiratory conditions?	No	1	No
Do you have any rare diseases that increase your risk from infections?	No	1	No
Are you currently receiving any immunosuppression therapies?	No	1	No
If you are female - are you pregnant?	No	1	No
Are you 70 years old or older?	No	1	No
Do you have any chronic heart disease?	No	1	No
Do you have chronic kidney diseases?	No	1	No
Do you have any liver disease conditions such as hepatitis?	No	1	No
Do you have any chronic neurological conditions?	No	1	No
Do you have diabetes?	No	1	No
Are you currently taking any steroids?	No	1	No
Do you have a weakened immune system as the result of conditions such as HIV/AIDS?	No	1	No
Have you had a 1st Covid-19 vaccination?	Yes	1	No
Date Received	30/06/2021
Have you had a 2nd Covid-19 vaccination?	Yes	1	No
Date Received	30/06/2021
Possible total score: 174	Total	196	Percentage 113%
Lifestyle
Do you smoke cigarettes or other tobacco products?	No	8	No
Have you ever smoked in the past and have now given up?	No	1	No
Do you drink alcohol?	Yes	1	No
How many units of alcohol do you drink in a week?	<10	4	No
Have you ever taken illicit drugs?	No	8	No
Do you eat a regular balanced diet?	Yes	4	No
Do you take regular excercise?	Yes	2	No
How many times a week do you exercise?	2 to 3	4	No
Possible total score: 35	Total	32	Percentage 91%
Manual Handling
Do you have any personal or health issues that could affect you standing for long periods of times?	No	2	No
Do you have any personal or health issues that could affect you pushing, pulling, carrying or lifting goods up to 25kg?	No	2	No
Do you have any personal or health issues that could affect you climbing stairs or ladders?	No	2	No
Do you have any personal or health issues that could affect you reading, writing or understanding non verbal information?	No	2	No
Do you have any personal or health issues that could affect you stretching or reaching or walking up to 1 mile?	No	2	No
Possible total score: 10	Total	10	Percentage 100%
Lone Working
Do you have any personal or health issues that could affect you working on your own?	No	2	No
Do you carry any medi-alert information e.g. related to medical conditions or allergies?	No	2	No
Do you suffer with epilepsy?	No	8	No
Possible total score: 12	Total	12	Percentage 100%
DSE User
Have you ever suffered from prolonged back pain ?	No	8	No
Have you ever suffered from whiplash injury at any time?	No	12	No
Have you ever suffered from pain as a result of carrying out repetitive tasks?	No	8	No
Have you ever suffered from headaches as a result of using a computer?	No	2	No
Do you need to wear glasses or contact lenses when working at a computer screen or reading ?	No	4	No
When did you last have an eye test?	<1 year	3	No
Have you ever suffered pain as a result of wearing head phones?	No	2	No
Are you allergic to any fabrics e.g. wool or polyester?	No	2	No
Do you have any personal or health issues that could affect you working in a hot or cold environment?	No	2	No
Possible total score: 43	Total	43	Percentage 100%
Shift Working
Do you have any personal or health issues that could affect you working shifts?	No	2	No
Have you any personal or health issues that could affect you eating meals at irregular times?	No	2	No
Have you ever been diagnosed with a sleep disorders?	No	2	No
Have you ever been advised by a medical specialist not to work shifts?	No	6	No
On the grounds of health have you ever been suspended by a previous employer from working shifts?	No	2	No
Have you worked a shift pattern in the past?	Yes	2	No
Did you experience any personal or health problems working shifts?	No	2	No
Possible total score: 18	Total	18	Percentage 100%
Mobile working / Vocational Driving
Have you any personal or health issues that may affect you working as a mobile worker?	No	2	No
Have you ever had a driving license suspended or revoked on medical grounds OR have you ever had to inform the DVLA of any medical conditions that would affect your ability to drive.	No	4	No
Do you have any personal or health issues that could affect you working on your own unsupervised?	No	2	No
Do you have any medical condition and/or take any medication that could cause sudden loss of consciousness Or have you ever suffered from sudden loss of consciousness”?	No	2	No
Possible total score: 10	Total	10	Percentage 100%
Healthcare Blood Validation
The following details are required to validate your immunisation status you will be required to provide answers and evidence of your status which can be uploaded to Fit4jobs.	Continue	0	No
Do you have your Hep B 1st Surface Antibody HBsAb Result?	No	0	No
Do you have documented (Identity Validated Sample - IVS) proof of a blood test for HIV1?	No	0	No
Do you have proof of a blood test for HIV2?	No	0	No
Do you have documented (Identity Validated Sample - IVS) proof for Hepatitis C Antibody?	No	0	No
Can you provide evidence for the previous Blood Test questions?	No	0	No
Do you have documented (Identity Validated Sample - IVS) proof of a Hep B Surface Antigen HBsAg Result?	No	0	No
Possible total score: 0	Total	0	Percentage 100%
Healthcare Vaccination Validation
As part of your employment it is necessary that you have valid imunisation status or that you may require vaccinations to be given to you for your protection and or for public health safety. You may be asked for documented evidence to be provided this should be scanned and uploaded into Fit4jobs where your data will be securely stored Please view the assistance video or contact our nurse contact centre on 0845 643 0355 if you require assistance.	Continue	0	No
Have you had vaccinations for Hepatitis B?	No	0	Yes
Have you been vaccinated, or had a positive immunity test for Measles and Rubella? (MMR)	Yes	0	No
MMR 1st Vaccination - Date Received	09/06/2004
MMR 1st Vaccination - Location Received	Right arm
Have you had a 2nd vaccination for MMR (Measles Mumps & Rubella)?	Yes	0	No
MMR 2nd Vaccination - Date Received	10/07/2007
MMR 2nd Vaccination - Location Received	Left arm
Have you been vaccinated, or had a positive immunity test for Varicella (Chicken Pox) / Shingles?	No	0	Yes
Have you had a vaccination for Tetanus?	Yes	0	No
Date Received	10/07/2007
Location Received	Right arm
Have you had a vaccination for Polio?	Yes	0	No
Date Received	11/05/2017
Location Received	Unknown
Have you had a vaccination for Diptheria?	Yes	0	No
Date Received	10/07/2007
Location Received	Right arm
Can you provide evidence of a BCG Vaccination?	No	0	Yes
Have you been tested for TB?	No	0	Yes
Have you ever been diagnosed with TB?	No	0	No
Have you had a cough that has lasted for more than 3 weeks?	No	0	No
Have you experienced unexplained weight loss?	No	0	No
Have you ever suffered from an unexplained fever?	No	0	No
Have you lived outside the UK for more than 3 months?	No	0	No
Have you been in recent contact with open TB?	No	0	No
Can you provide evidence for the previous Vaccination questions?	Yes - Upload	0	No
Please upload your evidence	Download Document
Do you have any other evidence to upload?	No	0	No
Where you born and raised outside the United Kingdom?	No	0	No
Past infection for Varicella (Chicken Pox) or Shingles OUTSIDE THE UK?	No	0	No
Definite verbal confirmation of past infection for Varicella (Chicken Pox) or Shingles WITHIN THE UK?	Yes	0	Yes
Do you have a BCG Scar?	No	0	Yes
Have you had a Pertussis Vaccine in the last 5 years?	No	0	Yes
Possible total score: 0	Total	0	Percentage 100%
Covid-19 SARS-cov-2
Have you been tested for Covid-19?	Yes	1	No
When were you tested?	15/01/2022
What was the test result?	Negative	0	No
Do you currently have any symptoms of Covid-19?	No	2	No
Are you a Healthcare Worker?	Yes	0	No
Are you or do you live with a Vulnerable person?	No	1	No
Possible total score: 0	Total	4	Percentage 100%
Restraint / Man Handling
Please be aware that as part of this process, you may be referred for an assessment in due course.	I understand	0	No
Do you have any history of fractures or surgeries or have you received any physical rehabilitation such as physio or other physical therapies?	No	0	No
Are you physically restricted in any of your normal day to day activities?	No	0	No
Can you easily manipulate zips & buttons?	Yes	0	No
Can you lift both of your arms above your head easily, without pain or restriction?	Yes	0	No
Can you kneel & lie on the floor, without assistance & return to standing, without issue or restriction?	Yes	0	No
Can you walk for up to an hour without requiring rest breaks or time to stop due to joint or muscle pain?	Yes	0	No
Do you have any aches, pains or recurring injuries?	No	0	No
Possible total score: 0	Total	0	Percentage 100%

Health Qualifying Rate

80%

Is Suitable Pass Score

245

Highest Possible Score

307

Service	Date Cleared	Validated
Healthcare Blood & Vaccination Validation
Varicella Serology Immunity
HEP B Antibody
Measles Immunity
Rubella Immunity
HEP B Vaccination
Stage 1 Hep B Vaccination
Stage 2 Hep B Vaccination
Stage 3 Hep B Vaccination
MMR 1st Vaccination
MMR 2nd Vaccination
Varicella 1st Vaccination
Varicella 2nd Vaccination
BCG Scar Check

Health Validation/Management Referrals