Occupational Health Questionnaire

The occupational health questionnaire is a survey form issued to prospective employees of specific companies for purposes of gauging their physical and mental fitness. From the survey data, the organisations are then able to gauge the individual respondent’s ability to handle the pressures and demands of the specific career. With the data obtained from the survey, medical advisers usually employed by the respective organisations are then able to decide whether the prospective employees need special assistance during training or whether their mental and physical well-being is enough to handle the demands at the workplace. Below is a sample standard occupational questionnaire.

Occupational Health Questionnaires

Q1.  Do you have any physical or known mental conditions that may make working with other people hard for you?

Q2. Do you suffer from sudden dizziness or any other condition that may hamper your working with automated machines?

Q3. Do you have any pre-existing medical condition that you don’t consider a threat to your work? _________.  If so, specify_______________________

Q4. Have you ever suffered seizures before_______?

If yes, how frequent were they_____________

Q5.  When you are not feeling well, what action best describes what you do? (Circle one)

a.Call in sick

b.Take some over the counter medicine and report to work

c. Go for a medical check-up  and later report to work

d.Seek medical attention and asks the doctor’s opinion on whether I should report to work or not

Q6.  Have you ever been injured at work?

If yes, describe the cause of your injury _____________________________________________________________

Q7. Do you suffer from any condition that may affect your attention at work? _____

Category: Health Questionnaire

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