Health Self-Assessment

Your answers will be considered only to the extent that they are related to your ability to safely perform your assignment/contract. Some answers may require a physician's release to work.

1. Do you have any condition or impairment that prevents you from performing the essential functions of the position you have been hired to fill?

2. Do you have any health conditions that may be of potential risk to patients/residents/students with whom you may come into contact while working in the position you have been assigned or contracted to perform?

The preceding answers are true to the best of my knowledge and ability. I understand this will be part of my personnel health file, and that falsifying answers could lead to disciplinary action, up to and including termination.


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Document name: Health Self-Assessment - Favorite
lock iconUnique Document ID: 87c2dc24d2a2c8b54e9c4f44df20d36f5a62f754
Timestamp Audit
March 9, 2023 12:16 pm EDTHealth Self-Assessment - Favorite Uploaded by Assist Medical Staffing - IP
March 9, 2023 12:17 pm EDT Document owner has handed over this document to 2023-03-09 12:17:13 -