Clinical · free template

Occupational Health Form

Occupational health questionnaire covering the job's demands, current health, workplace exposures, adjustments needed and fitness advice sought.

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

Questions
25
Pages
3
Layouts
classic · card
Time to complete
≈ 9 min
Conditional rules
4
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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 3 — The job

Role and demands

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

Every question on this page is currently visible.

Compliance checklist

Ready to publish
  • Payment items priced — passingEvery payment question charges a real amount, so a submission always records a payment.
  • Conditional logic resolves — passingEvery rule points at a question or page that exists in this template.
  • Medical disclaimer present — passingThis form does not provide medical advice, diagnosis or treatment. Information you share here is not a substitute for care from a qualified clinician. In an emergency, contact your local emergency service immediately.
  • Question labels unique — passingLogic and exports address questions by label, so duplicates are ambiguous.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

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.

About this template

Occupational health assessments answer a narrow question — can this person do this job safely, and what would help — so the form has to describe the job as precisely as the person. Page one records the employee, the role, and the physical and cognitive demands it actually involves: lifting, standing, driving, night shifts, working at height, display screen work and hours. Page two covers current health as it relates to that work: conditions and how they affect work, medication that could matter for safety-critical tasks, hearing and vision, mental health and anything the employee finds difficult in the role. Page three covers exposures and history — noise, dust, chemicals, vibration, respiratory or skin problems at work — and then the part that makes the assessment worthwhile: what adjustments the employee thinks would help, what has been tried already and what they want the assessment to advise on. Consent to report to the employer is recorded explicitly, with the scope stated, because the boundary between advice to an employer and clinical detail is the thing these assessments most often blur.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

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

25 questions in total.

Example of a completed occupational health form

A sample assessment showing how an employee describes their role and any adjustments that would help.

Employee full name
Sanjay Kapoor
Job title
Warehouse team leader
What does the role involve?
Manual lifting, Long periods standing
Does the role involve safety-critical tasks?
No
Do you have a condition that affects your work?
Yes
How does it affect what you do?
Lower back discomfort after lifting for long periods
What adjustments do you think would help?
Rotating tasks to reduce continuous lifting
Consent to a report being sent to the employer
Advice only, with no clinical detail

Sample data — no real people, addresses or records are shown.

How the form changes as it's filled in

This template ships with 4 conditional rules, grouped into 4 behaviours driven by 4 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Does the role involve safety-critical tasks?”

  • Makes answers required

    If “Does the role involve safety-critical tasks?” is Yes, “Which tasks are safety-critical?” becomes required before the form can be submitted.

Driven by “Do you have a condition that affects your work?”

  • Makes answers required

    If “Do you have a condition that affects your work?” is Yes, “How does it affect what you do?” becomes required before the form can be submitted.

Driven by “Any exposure to noise, dust, chemicals or vibration?”

  • Makes answers required

    If “Any exposure to noise, dust, chemicals or vibration?” is Yes, “What exposure, and for how long each day?” becomes required before the form can be submitted.

Driven by “Consent to a report being sent to the employer”

  • Reveals questions

    If “Consent to a report being sent to the employer” is Advice only, with no clinical detail, the form reveals “Anything you do not want included”.

Set it up step by step

  1. 1

    Describe the job before the person

    Fitness advice is meaningless without the demands it is measured against, so page one exists to make the role concrete.

  2. 2

    Record consent scope explicitly

    Employees should choose between advice only and a fuller report, and the choice belongs in the record rather than in a covering email.

  3. 3

    Ask the employee what would help

    The adjustments people propose themselves are usually cheap, specific and far more likely to be used.

  4. 4

    Send advice, not diagnosis

    Report on capability and adjustments to the employer, and keep the clinical detail in the occupational health record.

Mistakes to avoid

  • Sending a clinical history to an employer who only needed advice on adjustments.
  • Assessing health with no description of the job's real demands.
  • Treating absence figures as the outcome rather than the adjustments that would change them.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Assess against the described demands, agree adjustments with the employee, and send the employer advice within the scope of consent that was recorded.

Works in both layouts

Browse classic templatesBrowse card templates

Forms that overlap this one

These pages cover the same subject ground as the occupational health form, matched on the words people actually search for.

Privacy & compliance

This form collects health information. Keep access limited to the people who need it, turn on encrypted answers for the clinical questions, and set a retention window so records don't sit in the dashboard forever.

Frequently asked questions

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.

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