Employee Health Survey
Survey Date: January 1, 2050 | Employee Name (optional): [Your Name] |
HEALTH ASSESSMENT
Have you experienced any recent health issues or symptoms that may affect your ability to work safely?
Are you currently taking any medication or undergoing any medical treatment that may impact your work performance or safety?
Have you been in contact with anyone diagnosed with a contagious illness in the past 14 days?
Are you experiencing any chronic health conditions that may require accommodations at work?
Have you had any recent injuries or accidents that may affect your work duties?
Are there any specific health concerns or accommodations you would like to discuss with the company?
ADDITIONAL COMMENTS
Please provide any additional comments or information related to your health or any specific concerns:
The information provided in this Employee Health Survey will be kept confidential and used solely for assessing and ensuring the health and safety of our workforce. Your cooperation in providing accurate information is essential for maintaining a safe workplace.
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