Health Surveillance & Data Protection Policy – Titan Drylining Forms Portal

Health Surveillance is a legal requirement and enables us to detect early signs of work related ill health. This enables us to determine if more training is needed or if we need to review our risk control measures.
Name:*
Date Of Birth:*
Current Address:
Emergency Contact - Name:*
Emergency Contact - Number:*
Do you experience any of the following symptoms? Please type 'yes or 'none'. If 'yes' please give details.
Coughing, wheezing, breathing difficulties, Asthma, Bronchitis, tuberculosis or any other chest or breathing issues?*
Itching, redness, excessive dryness, or blistering of skin?*
Ongoing pain, such as: back, hand, wrist, fingers, neck ect?*
Any health conditions that may need additional consideration for working on a construction site, impact your ability to perform certain tasks, pose a risk, need additional support or control measures (e.g. heart conditions, epilepsy, serious allergies)?*
Have you been to the doctor in the last year due to any of the above or anything that may be work related?*
Titan Drylining Ltd - Data Protection Policy (General Data Protection Regulations)

Please find full info here: Titan Data Protection Policy
I consent to Titan securely storing my data:*
- Opt-in
Signature*
Date*
DD slash MM slash YYYY