Additional Pre-Placement Health Screening Questions (Doctors and Dentists in Training)

To submit your answers to the additional Pre-Placement Health Screening questions, please complete the online form by answering each of the following questions. All fields marked * are required fields and must be completed. On submission a PDF summary of your completed form shall be emailed to GO Health Services and a copy sent to your own email address. If you securely retain this copy as you will be expected to produce this at the start of each rotation. If you have not already done so please also submit your TURAS Health Questionnaire ASAP.

This questionnaire will be held in confidence by GO Health Services and will form part of your Occupational Health record. For full details of how your personal information is used please see our GDPR Statement.

This form is also available in other formats and languages, upon request. Please Please call NHS Grampian Corporate Communications on (01224) 551116 or (01224) 552245 for further information.

Step 1 of 2

SECTION 1: PERSONAL DETAILS

Forename *

Surname *

GMC Number *

Date of Birth *

Mobile Phone Number *

Email Address *

Confirm Email

Have you ever worked or travelled abroad for more than 3 months? *

Do you consent for us to access any previous notes held on our systems (e.g. perhaps from your student records or from another employment)? *

Healthcare workers may be exposed to infectious hazards during the course of their employment and in certain circumstances may also transmit infections to patients. GO Health Services will send a report on your immunisation status to the Deanery (FY1 and FY2) or your Educational Supervisor (ST and CT). Do you consent to this? *

Additional Pre-Placement Health Screening Questions (Doctors and Dentists in Training)

SECTION 1: PERSONAL DETAILS

SECTION 2: YOUR HEALTH AND FUNCTIONAL CAPABILITIES

Skin Questions