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Night Workers Questionnaire

Night Worker Questionaire

Health questionaire to assess if you are fit to work nights.

The purpose of this questionaire is to make sure that you are suited to working at night. All the information you provide will be kept confidential.

Health Conditions

Do you suffer from any of the following health conditions?

Diabetes
Heart or circulatory disorders
Stomach or intestinal disorders
Any condition which causes difficulties sleeping
Chronic chest disorders (especially if night-time symptoms are troublesome)
Any medical condition requiring medication to a strict timetable
Any other health factors that might affect fitness at work

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Commercial Application Form
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Industrial Application Form
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48 Hour Opt-Out Agreement
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Holiday Request Form
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Number of days you would like to take as holiday
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Bank Details

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Address

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