Employee Medical Form Template UK

The Employee Medical Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, featuring both editable and printable versions.

Open – Template

Online – Template

Sample

Employee Medical Form Template UK

Editable – Printable

PDF – 1 PDF – 2

Employee Medical Form Template UK

1. Employee Information



2. General Health Information

3. Allergies

4. Medications

5. Emergency Contact Information


6. Medical History

7. Consent for Medical Treatment

8. Data Protection Declaration

9. Declaration and Signature


PDF

WORD

Examples

Employee Medical Form Template UK (1)
Employee Information:
[Employee Name]
[Employee ID]
[Department]
[Position]
[Contact Number]
Personal Details:
Date of Birth: [DOB]
Address: [Employee Address]
Emergency Contact: [Name and Contact Number]
Health History:
Do you have any existing medical conditions? [Yes/No]
If yes, please specify: [Details of conditions]
Allergies:
Do you have any allergies? [Yes/No]
If yes, please list them: [Details of allergies]
Medications:
Are you currently taking any medications? [Yes/No]
If yes, please list: [Details of medications]
Vaccination Status:
Have you received any vaccinations? [Yes/No]
If yes, please specify: [Details of vaccinations]
Doctor’s Information:
Doctor’s Name: [Doctor’s Name]
Clinic Name: [Clinic Name]
Contact Number: [Doctor’s Contact Number]
Signature:
I hereby confirm that the information provided is accurate and current to the best of my knowledge.
[Signature of the Employee]
[Date]
Employee Medical Form Template UK (2)
Employee Details:
Name: [Employee Name]
Employee ID: [Employee ID]
Department: [Department]
Phone: [Contact Number]
Personal Information:
Date of Birth: [DOB]
Home Address: [Employee Address]
Emergency Contact Person: [Name & Phone Number]
Medical History:
Have you had any serious illnesses or surgeries? [Yes/No]
If yes, please explain: [Details of illnesses/surgeries]
Allergic Reactions:
Do you have any known allergies? [Yes/No]
If yes, please provide details: [Allergen Information]
Current Medications:
Are you currently under any medication? [Yes/No]
If yes, please list: [Medication Details]
Vaccination Details:
Have you been vaccinated for [Specific Diseases, e.g., Flu, COVID-19]? [Yes/No]
If yes, please specify: [Vaccination Details]
Primary Care Physician:
Physician’s Name: [Doctor’s Name]
Practice Name: [Practice Name]
Phone: [Physician’s Phone Number]
Declaration:
I declare that the details provided above are true and complete.
[Signature of the Employee]
[Date]

Printable

PDF – 1 PDF – 2

Employee Medical Form Template UK