The Medical Fitness Declaration Form is a crucial document used in New Zealand workplaces to assess and document an individual's health status and fitness for specific roles or activities. This document is typically required during pre-employment processes, return-to-work assessments, or when specific role requirements change. It aligns with New Zealand's robust health and safety framework, including the Health and Safety at Work Act 2015 and Privacy Act 2020, ensuring proper collection and handling of sensitive medical information. The form helps organizations fulfill their duty of care obligations while protecting employee privacy and maintaining workplace safety standards. It includes sections for personal information, medical history, current health status, and specific capability declarations relevant to the role's requirements.
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1. Personal Information: Collection of basic details including full name, date of birth, contact information, and any relevant ID numbers
2. Privacy Notice: Statement explaining how the medical information will be collected, used, stored, and shared, in compliance with the Privacy Act 2020 and Health Information Privacy Code
3. General Health Declaration: Overall statement of current health status and fitness for intended purpose
4. Medical History: Declaration of relevant past medical conditions, surgeries, and ongoing health issues
5. Current Medical Conditions: Details of any current medical conditions, medications, or treatments
6. Physical Capabilities: Declaration of ability to perform specific physical tasks relevant to the role or purpose
7. Consent and Declaration: Formal declaration of truth and consent for information verification, including authorization for medical checks if required
1. Specific Risk Factors: Additional questions related to specific workplace hazards or risks - include when the role involves particular health and safety risks
2. Mental Health Declaration: Section focusing on mental health status - include when mental health is particularly relevant to the role or purpose
3. Infectious Disease Status: Questions about specific infectious diseases - include during public health emergencies or for healthcare roles
4. Disability Accommodation: Section for declaring any required workplace accommodations - include when relevant to workplace adjustment needs
5. Emergency Medical Information: Emergency contact details and critical medical information - include for high-risk work environments
6. Genetic Information Declaration: Information about genetic conditions - include only when specifically relevant and legally permitted
7. Drug and Alcohol Declaration: Specific questions about substance use - include for safety-sensitive positions
1. Schedule A - Medical Requirements: Detailed list of medical requirements and standards for the specific role or purpose
2. Schedule B - Privacy Policy: Detailed privacy policy and information handling procedures
3. Schedule C - Medical Assessment Criteria: Specific criteria used to assess medical fitness for the role
4. Appendix 1 - Health Monitoring Requirements: Details of any ongoing health monitoring requirements
5. Appendix 2 - Authorized Medical Practitioners: List of approved healthcare providers for medical assessments if applicable
6. Appendix 3 - Risk Assessment Matrix: Matrix showing health risks associated with specific job functions
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Healthcare
Construction
Manufacturing
Mining
Transportation
Aviation
Maritime
Emergency Services
Sports and Recreation
Education
Food Services
Security Services
Oil and Gas
Agriculture
Defense
Relevant Teams
Human Resources
Occupational Health and Safety
Risk Management
Compliance
Operations
Medical Services
Employee Relations
Training and Development
Quality Assurance
Emergency Response
Relevant Roles
Construction Worker
Machine Operator
Pilot
Healthcare Worker
Emergency Responder
Security Guard
Driver
Offshore Worker
Factory Worker
Military Personnel
Sports Coach
Teacher
Food Handler
Mining Engineer
Ship Crew Member
Police Officer
Firefighter
Paramedic
Warehouse Operator
Maintenance Technician
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