Candidate Information Health Check

							Candidate Information Health Check
                                                                        Confidential
Personal Details
Candidate Name _______________________               Date of Birth ____________
Address: ___________________________            (dd / mm / yy)
         ___________________________
          __________________________
Telephone Number: _____________________ (in case of emergency)
Course Title ___________________________ Course Date ___________

Health Check


Please tick in the appropriate column                      If ‘Yes’ please give details
                                               Yes   No
Are you diabetic?

Do you suffer with a back problem?

Do you suffer from any joint or muscle
problems?
Have you any mobility impairment?

Do you suffer from any cardiovascular
conditions?
Do you have any sight impairment?

Do you suffer from Hand Arm Vibration
Syndrome?
Do you suffer from any balance disorders?

Do you suffer from deafness?

Are you epileptic?

Are you currently on any medication?

Do you have any dependency (drugs, alcohol)?

Learning

Do you have any learning disability (eg.
Literacy, Numeracy, Dyslexia)?
Do you have a criminal record or any
outstanding court proceedings or are you on
any offender’s register?
                  HEALTH AND SAFETY POLICY STATEMENT
The Principal and Board of Governors of Bicton College consider the health and safety of
employees, learners, and any other persons affected by its activities, to be of paramount
importance. Safety management will, form an integral part of the College’s key business
objectives, and will be allotted sufficient staff time and resources. In particular the college
will undertake to promote the concept of the “safe learner”, by ensuring that learners,
whether on a training programme at, or on behalf of the college, or on a work based
learning programme receive high quality and vocationally relevant health and safety
information and instruction, and are equipped to be safe and healthy workers.

Specifically in the College the Director of Finance and Planning along with the College
Campus Manager are responsible for Health and Safety management and will ensure that
at the very least the College adheres to the requirements of the 1974 Health and Safety
at Work Act and all subsequent legislation. They will be responsible for formulating policy,
organising staff, reviewing, monitoring and improving performance and providing an
annual Health and Safety report for the Board of Governors. Additionally other College
managers will be responsible for the daily management of Health and Safety in their
respective work areas. All other staff and learners will be responsible for ensuring that
they comply with any safety instructions or information that they are given and do not
endanger themselves or others while working, studying or living at the College.
Everybody at Bicton has a key part to play in achieving the aims of this Policy and are
positively encouraged to assist in any way possible. There will be opportunities for staff to
raise safety concerns or make suggestions for improvements through their department
managers, the College Campus Manager or the Director of Finance and Planning.

It is also the Policy of Bicton College to provide, so far as is reasonably practicable, safe
and healthy working conditions, work equipment and premises for its employees, learners
and visitors. The College will ensure that staff and students learners receive the
necessary information, instruction and training to allow them to undertake their duties in a
safe manner, and that appropriate information is also given to all other persons working
on, or visiting, its premises.

This Policy will be reviewed annually or earlier if circumstances should so warrant.


Principal

The College reserves the right to refuse training or assessments to anyone who is suspected of
recently using either drugs or alcohol.
I freely give this information to make the College aware of any medical condition which may affect
my participation in this course. The information I have given is correct.


Signed ………………………………………                              Date …………..……………



FOR OFFICIAL USE
Instructor/Assessor Initials   CCM           STF            Other