Pre-Employment Health Check Test

1. Any condition that would be adversely impacted by working for long periods of time in a cold environment? *

2. Abnormal shortness of breath, leg pain or chest pain or exertion? *

4. Anxiety, depression or other psychiatric disorder? If you answered yes (Y) please give more details below including when it occurred. *

5. Are you, or should you, be taking any medication from your doctor or chemist or receiving treatment for any condition? (Include items such as eyedrops, asthma puffers, nasal sprays, creams, physiotherapy) *

6. Back pain lasting more than two weeks? *

7. Diabetes? *

19. Fractured bones? *

Declaration *