New Starter Medical Questionnaire To be completed by the employer Name* First Middle Last Job title / description*Please give your proposed job title and if possible a brief description of the workWill the role involve:1. Shift / Night work?*YesNo2. VDU work?*YesNo3. Manual handling?*YesNo4. Working with chemicals?*YesNo5. Fork Lift Truck / Pallet Truck driving?*YesNo6. Tasks where colour recognition is critical?*YesNo7. Driving (apart from vehicles listed in question 5)?*YesNo8. Using oils, greases or lubricants?*YesNo9. Machinery operation?*YesNo10. Lone working?*YesNo11. Working with respiratory sensitisers?*YesNo12. Confined spaces?*YesNo13. Work at height?*YesNo14. Noise?*YesNo15. Temperature extremes?*YesNo16. Vibrating tools / equipment?*YesNo17. Electromagnetism?*YesNoName of HR person submitting these details:*CAPTCHANameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.