HR Medical Questionnaire

An HR medical questionnaire is an official document which is drafted to assess the medical history of the HR employees. The questions asked in the questionnaire give information about the healthy or unhealthy habits of the individual and also whether they are medically fit to work in the organization.

Sample HR Medical Questionnaire:

Name: _____________________

Date of Birth: ____/____/____

Street Address: Street: ____________ City: ___________, State: ___________, PIN: _____________

Mobile number: _______________

Residential Phone Number: ______________

Email Address: _____________________

Position applied for: ___________

Q1. Do you have any form of disability? If yes, please specify.

_______________________

Q2. D you have any type of skin disease?

a)   Yes

b)   No

Q3. Do you suffer from any of the following that can act as a hindrance in your work?

a)   Asthma

b)   Migraine

c)   Hay fever

d)   Spondylisis

Q4. Are you allergic or sensitive to any drugs, antibiotics or any type of food?

a)   Yes

b)   No

Q5. If your answer is yes, please specify?

___________________

Q6. When was the last time that you were hospitalized?

a)   In last one year

b)   In last two years

c)   In last five years

d)   More than five years back

Q7. What was the reason for getting hospitalized?

_______________

Q8. Do you or anyone in your family have history of heart disease?

__________________

Q9. Do you suffer from high blood pressure?

a)   Yes

b)   Sometimes

c)   No

Q10. How many hours of sleep do you get every night?

_____________________

Q11. Currently are you on any medication?? If yes, then please provide the details?

_______________________________________________

Category: HR Questionnaires