Are you new to NHS Grampian or an existing staff member? * New staff member to NHS Grampian Existing NHS Grampian staff member
Job Reference Number *
Job Applied For *
Type of Job Applied For * Full-time Part-time Bank Locum
Main Location of Job Applied For (nearest major town or city in Grampian) * Aberdeen Aberlour Aboyne Alford Ballatar Banchory Banff Braemar Buckie Elgin Ellon Forres Fraserburgh Huntly Keith Laurencekirk Lossiemouth Macduff Peterhead Stonehaven Turriff Westhill
Intake Year * 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012
Area of Study * Medicine Dentistry Physician Associate Studies Clinical Elective from another University
Intake * Return to Practice 2024 (September) 2024 (January) 2023 (September) 2023 (January) 2022 (September) 2022 (January) 2021 (September) 2021 (January) 2020 (September) 2020 (January) 2019 (September) 2019 (January) 2018 (September) 2018 (January) 2017 (September) 2017 (January)
School * School of Health Sciences School of Nursing, Midwifery and Paramedic Practice School of Pharmacy and Life Sciences
Course * B Midwifery BSc Nursing – Adult BSc Nursing – Children and Young People BSc Nursing – Mental Health BSc Paramedic Practice BSc Nursing (Hons) BSc Nursing (Hons) – Dual Reg. Adult and Children and Young People BSc Nursing (Hons) – Dual Reg. Adult and Mental Health BSc Nursing (Hons) – Dual Reg. Children and Young People and Mental Health BSc (Hons) – Applied Biomedical Science BSc (Hons) – Diagnostic Radiography BSc (Hons) – Nutrition and Dietetics BSc (Hons) – Occupational Therapy BSc (Hons) – Physiotherapy Master of Pharmacy MDiet Dietetics MDRad Diagnostic Radiography MOccTh Occupational Therapy MPhys Physiotherapy MSc Midwifery MSc Physiotherapy (pre-reg) Return to Practice
Have you taken time out and are returning to the course? * Yes No
Please confirm if either of the following apply to you or leave blank Erasmus Exchange Student HNC entry to 2nd Year Nursing Student
If you have attended an Occupational Health department before please provide details and dates
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)? * Yes No
Have you ever worked or travelled abroad for more than 3 months? * Yes No
Please indicate in which country(s) and for how long
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 provide your manager with information on your immunisation status. Do you agree for GO Health Services to advise your manager? * Yes No
Job Title
Summary of Role / Location
Mobility (e.g. walking, running, using stairs): * Yes No
Please provide further details (e.g. extent of impairment, how you manage, any support needs): *
Agility (e.g. bending, reaching up, kneeling down, maintaining balance): * Yes No
Please provide further details (e.g. extent of impairment, how you manage, any support needs): *
Dexterity (e.g. getting dressed, writing, using tools): * Yes No
Please provide further details (e.g. extent of impairment, how you manage, any support needs): *
Physical Exertion (e.g. lifting, carrying, running): * Yes No
Please provide further details (e.g. extent of impairment, how you manage, any support needs): *
Communication (e.g. speech, hearing): * Yes No
Please provide further details (e.g. extent of impairment, how you manage, any support needs): *
Vision (e.g. visual impairment, colour blindness, tunnel vision): * Yes No
Please provide further details (e.g. extent of impairment, how you manage, any support needs): *
Do you have any learning issues (e.g. dyslexia, dyspraxia, dyscalculia, impaired concentration)? * Yes No
Please provide further details below: *
Do you have a diagnosed health condition? * Yes No
Please provide details of the condition and any specialist input: *
Are you currently taking any medication or treatment (or in the last 12 months)? * Yes No
Please provide details: *
Do you have any illness / Impairment / disability (physical or psychological) which may affect your work?* * Yes No
Please give details with dates: *
Have you developed any illness / impairment / disability which may have been caused or made worse by your work?* * Yes No
Please give details with dates: *
Do you have any medical conditions or are you waiting for treatment / investigation at present?* * Yes No
Please give details with dates: *
Do you have any allergies or have you had a reaction to any medications or vaccines?* * Yes No
Please give details with dates: *
Do you think you may need any adjustments or assistance to help you to do the post you are applying for?* * Yes No
Please give details with dates: *
Coughing up blood or long-term productive cough: * Yes No
Please provide details (e.g. when condition developed, how long it lasted, its effects on you, treatment): *
Unexplained weight loss: * Yes No
Please provide details (e.g. when condition developed, how long it lasted, its effects on you, treatment): *
Unexplained fever, night sweats, or high temperature: * Yes No
Please provide details (e.g. when condition developed, how long it lasted, its effects on you, treatment): *
Been in contact with TB? * Yes No
Please provide details (e.g. when condition developed, how long it lasted, its effects on you, treatment): *
Have you previously been vaccinated against TB (BCG Vaccination)? * Yes No
Do you have a visible scar or documentation from having BCG vaccination? * Yes No
Have you had a Mantoux or IGRA test in the past? * Yes No
What was the result of the Mantoux or IGRA test?
Have you suffered from any skin problems in the past 12 months? * Yes No
Please provide details: *
Have you ever had a skin reaction to a substance in the work place? * Yes No
Please provide details: *
Do you currently need any workplace adjustments for your skin (e.g. particular gloves, different soap, avoiding scrubbing)? * Yes No
Please provide details: *
Does your skin issue affect your hands or forearms? * Yes No Not Applicable
Please provide details: *
Do you think your skin issue is made worse by work? * Yes No Not Applicable
Please provide details: *
Have you needed time off work in the last 12 months due to this skin problem? * Yes No Not Applicable
Please provide details: *
Do you have any known difficulties with PPE (e.g. masks, gloves)? * Yes No
Please provide details: *