Healthcare & Clinical · community shared

Occupational Health Form — shared by the community

Rachel O. shared this 25-question build with 4 conditional rules already wired up. Test it below, then take a copy.

A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 25 questions, 3 pages, 4 conditional rules.

Shared by
Rachel O. · Events coordinator
Questions
25
Replies
15
Copies taken
736
See the library version

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Live preview and test console

This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.

Page 1 of 3The job

Role and demands

What does the role involve?
Does the role involve safety-critical tasks?

Every question on this page is currently visible.

Works for you? Take Rachel O.'s copy into your own workspace — questions, rules and settings included.

Who this template is for

Occupational Health Form is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.

  • Small teams who need a reliable intake process working in healthcare & clinical.
  • Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
  • Anyone replacing chasing missing details over email with one structured record per enquiry.
  • Respondents are the people you send it to — the form asks them 25 questions across 3 screens.
  • Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.

  • 15 questions are required, so submissions arrive complete instead of needing a follow-up email.
  • It records a signature you can keep as proof of agreement.
  • It pins the request to a specific date.
  • It allows multiple selections without free text.
  • It captures a numeric value you can filter and sort on.
  • Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.
  • Splitting the form across 3 pages keeps each screen short and shows respondents how much is left.
  • Every response is stored, searchable and exportable, so nothing depends on one person's inbox.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

  1. 1Press “Use this template” — a fresh copy of Occupational Health Form lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
  4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
  5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

  • Features conditional validation: if “Does the role involve safety-critical tasks?” is Yes, “Which tasks are safety-critical?” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Do you have a condition that affects your work?” is Yes, “How does it affect what you do?” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Any exposure to noise, dust, chemicals or vibration?” is Yes, “What exposure, and for how long each day?” becomes mandatory before the form can be sent.
  • Features advanced show logic: if “Consent to a report being sent to the employer” is Advice only, with no clinical detail, the form dynamically exposes “Anything you do not want included”. Otherwise that question never appears.
  • All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

What this form asks

Page 1 — The job

  • Employee full namerequired
  • Date of birthrequired
  • Job titlerequired
  • Employer or departmentrequired
  • What does the role involve?required
  • Usual hours a weekrequired
  • Does the role involve safety-critical tasks?required
  • Which tasks are safety-critical?

Page 2 — Your health at work

  • Do you have a condition that affects your work?required
  • How does it affect what you do?
  • Current medication
  • Any difficulty with hearing?required
  • Any difficulty with vision, corrected or not?required
  • Anything about work affecting your mental health
  • Tasks you find difficult in this role
  • Days absent from work in the last year

Page 3 — Exposures and adjustments

  • Any exposure to noise, dust, chemicals or vibration?required
  • What exposure, and for how long each day?
  • Any breathing or skin problems that are worse at work
  • What adjustments do you think would help?required
  • What has already been tried?
  • What should this assessment advise on?required
  • Consent to a report being sent to the employerrequired
  • Anything you do not want included
  • Signaturerequired

Conditional logic in this build

  • WhenDoes the role involve safety-critical tasks?is Yes, requireWhich tasks are safety-critical?”.
  • WhenDo you have a condition that affects your work?is Yes, requireHow does it affect what you do?”.
  • WhenAny exposure to noise, dust, chemicals or vibration?is Yes, requireWhat exposure, and for how long each day?”.
  • WhenConsent to a report being sent to the employeris Advice only, with no clinical detail, showAnything you do not want included”.

Questions about this shared form

Can employers see the whole submission?

Only if the employee consented to a full report. The consent question exists so the boundary is documented, and advice-only is a legitimate and common choice.

Is this a pre-employment or a return-to-work form?

It works for both, because the demands and adjustments questions are the same. Add a start-date or absence-dates field for whichever process you are running.

Does it decide fitness for work?

No. It gathers the information an occupational health clinician needs to give that advice; nothing in the form produces a conclusion on its own.

How long should these records be kept?

Occupational health records often carry longer retention than general employment files, particularly where exposures are recorded, so set the schedule against the rules for your industry.

Is the Occupational Health Form template free to use?

Yes. You can preview and test Occupational Health Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Occupational Health Form template ask for?

It asks 25 questions across 3 pages, 15 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Occupational Health Form form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this healthcare & clinical form work?

4 conditional rules ship with the template: Features conditional validation: if “Does the role involve safety-critical tasks?” is Yes, “Which tasks are safety-critical?” becomes mandatory before the form can be sent. Features conditional validation: if “Do you have a condition that affects your work?” is Yes, “How does it affect what you do?” becomes mandatory before the form can be sent. Features conditional validation: if “Any exposure to noise, dust, chemicals or vibration?” is Yes, “What exposure, and for how long each day?” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.

Where do responses to the Occupational Health Form form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Occupational Health Form form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

Is the signature on this form legally usable?

The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.