medical declaration

Please complete this form and submit

CONSENT

I consent to provide a medical declaration to Phoenix Solutions for:

Identification of any pre-existing conditions that may affect my ability to perform my role during my employment with Phoenix Solutions.
Identification of any allergies, illness or health conditions that may be
required to be considered in the event of a medical emergency.

I understand that my personal medical records will remain confidential in accordance with the Privacy Act 1993 and the Privacy Act 2020. The

completed medical declaration will be stored onsite at the company with restricted access. I understand that I will be able to access and update the information at any time, and that this information will be disposed of as per the relevant legislation. I understand that I do not have to provide this information, but I am doing so knowing that the information declared will be used for the purpose of ensuring my health, safety and well-being whilst engaged in undertaking my role at Phoenix Solutions.

I have read and understood the terms of this consent form and agree to provide a medical declaration.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Date

PERSONAL DETAILS

First name

Last name

Date of birth

Day

Month

Year

< Back to Resources