Occupational HealthCorporate BookingsCompany Name * RequiredCompany Booking Officer * RequiredCompany Booking Officer EmailCompany Contact Number * RequiredEmail to send results to * Required Billing Company (if different)CommentsCandidate's Name * Required First Last Job Role (if known)Type of Medical / Assessment * Required Components Only (Example: Audio only, Spiro only, Das only etc) Pre-Employment Medical Periodic Medical Health Monitoring Medical Commercial Drivers Medical UKOG Medical Railway Medical (Cat 1) Railway Medical (Cat 2) Railway Medical (Cat 3) Fitness for Work Assessment (Mental Health or Injury related) Health Surveillance Medical Lead Arsenic Asbestos Silica Isocyanates Please call the Corporate Team to discuss further.Functional (if applicable) With Fitness Without Fitness Fitness Only Audiometry (if applicable) Standard Regulation 58 Audiometry Testing Please ensure candidate has completed 16 hours of quiet time, prior to the Reg58 audio. Employer to complete Form 18 prior to appointmentSpirometry (if applicable) Yes No Drug and Alcohol (if applicable) Instant DAS Laboratory DAS Instant 15 Panel Supervised Observed ECG (if applicable) Yes No Blood Testing (if applicable) HBA1c – Fasting HBA1c – Non-Fasting Total Cholesterol HDL / LDL – Fasting Total Cholesterol HDL / LDL – Non-Fasting Chest X-Ray (if applicable) Standard ILO Reporting Chest CT Scan (if applicable) Yes No Travel Medical and Vaccinations (if applicable) Yes No Please call the Corporate Team to discuss further.Q Fever (if applicable) Yes No CommentsPO NumberPreferred Booking Date DD slash MM slash YYYY Preferred Booking Time Morning (AM) Afternoon (PM) Any CommentsMedical Paperwork Use Brecken Health Paperwork Use Company specific Paperwork – please upload below. Paperwork Drop files here or Select filesMax. file size: 25 MB.If there is specific paperwork required, please upload here.Maximum file size – 25 mega bytes. Δ
