Care Work can be stressful and demanding, and it is part of our registration process to ensure that all candidates are fit
to work in such circumstances.
1. Have you ever been admitted to hospital (apart from childbirth)?
2. Have you ever had an accident at work?
3. Are you at present under medical supervision or taking any medicines?
4. Are you under psychiatric supervision?
5. Have you any disabilities or are you registered disabled?
6. Have you had any absence from work due to sickness in the last 2 years?
7. Do you have or have you ever had diabetes?
8. Have you or, to the best of your knowledge, any of your relatives, ever had TB?
9. Persistent or recurrent back trouble?
10. Mental illness or nervous breakdown (including time off work related to stress and/or depression)?
11. Migraines, blackouts, epilepsy, fainting?
12. Chronic chest complaint, persistent cough, asthma, coughing up blood or similar disorder?
13. Stomach or intestinal disorders, e.g. ulcer, bowel disorder, dysentery, typhoid, cholera,other chronic diarrhoea?
14. Hepatitis, jaundice or other liver disease?
15. Heart or circulatory disorders including angina or raised blood pressure?
16. Skin complaint or allergy? (Please specify)
17. Any condition which causes difficulties sleeping?
18. Have you ever had, or been vaccinated against, Hepatitis B?
19. Any other health factors that might affect your fitness to work in Social Care?
If you have answered 'YES' to any of the above Questions, please give details here. Use a continuation sheet if necessary.
I, the undersigned, confirm that the above information is correct to the best of my knowledge.