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Health Risk Assessment for Night Workers (OH4)
The Working Time Regulations require employees who are working nights to be
offered a free health assessment before they start working nights and
regularly thereafter whilst they continue to work nights.
Working at night affects the body's normal rhythms and this has the
potential to adversely affect the well being of the individual, particularly
those suffering certain health conditions. A generic risk assessment has
been carried out and a questionnaire produced to monitor the health of
employees who are or who are about to commence working nights.
Employees should be invited to complete a health questionnaire before they
commence working nights for the first time and annually at their final
performance management interview for as long as they continue to work
nights.
This may be completed electronically and returned to the Occupational Health
Adviser via e-mail. Any-one responding positively to the health
questionnaire will be invited to attend a health interview with the
Occupational Health adviser.
Definitions
A Night Worker - someone who works at least three hours each night.
Night Time - Between 23.00hrs and 06.00hrs.
Health Assessment - Questionnaire completed by employee and returned to the
Occupational Health adviser. Employees providing positive answers to the
health questionnaire will be invited to attend a health interview with the
Occupational Health Adviser. Health surveillance is voluntary.
Confidentiality -
Data protection -
Health Declaration for Night Workers
Please complete and return via e-mail to the Occupational Health adviser for
your location.
Place an 'X' In The Boxes that apply
Personal Details
Date:
Surname: Forename:
Date Of Birth:
Male Female
Job Title:
Location:
Tel:
Health Declaration
Do you suffer with any conditions or symptoms that may be adversely affected
by you working night shifts?
Indicate Yes (Y) or No (N) to the following questions:
Y N
Do you have diabetes?
Do you suffer with heart or circulation problems?
(including high blood pressure)
Do you suffer with any mental illness?
(including stress or depression)
Do you need to take medications on a regular basis?
Do you suffer with any conditions that affect your ability to sleep?
Do you suffer with any digestion disorders?
(including ulcers, indigestion & hiatus hernia)
Do you suffer with any condition not mentioned above that you believe may be
adversely affected by working night shifts?
(including new and expectant mothers)
If you have answered yes to any of the above questions you are invited to
see the OH adviser before commencing or continuing night shifts.
Please indicate whether you would like to see the OH adviser
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