The Employee Health Declaration Form is a essential document used in Irish employment contexts to collect and maintain accurate health information about employees. It is typically used during the onboarding process, when returning to work after extended illness, or when job responsibilities change. The form must comply with Irish legislation, including the Data Protection Act 2018, GDPR, and the Safety, Health and Welfare at Work Act 2005. It collects information about an employee's health status, medical history, and any conditions that might affect their work or require workplace accommodations, while ensuring proper handling of sensitive personal data. The document helps employers fulfill their duty of care while protecting employees' rights and privacy.
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1. Data Protection Notice: Statement explaining how the health data will be processed, stored, and protected in accordance with GDPR requirements
2. Personal Information: Basic details including name, employee ID, department, role, and contact information
3. General Health Status Declaration: Basic questions about current health status and any ongoing medical conditions that might affect work
4. Work-Related Health Concerns: Specific questions about health issues that could affect job performance or require workplace accommodations
5. Emergency Contact Information: Details of who to contact in case of medical emergency
6. Medical History: Relevant medical history that could impact workplace safety or job performance
7. Consent Declaration: Employee's explicit consent for processing health data and confirmation that information provided is accurate
8. Signature Section: Space for employee signature, date, and witness signature if required
1. Occupational Health Assessment: Additional section for roles requiring specific health assessments (e.g., heavy machinery operators, food handlers)
2. COVID-19 Declaration: Temporary section for pandemic-related health declarations when required by public health guidance
3. Disability Accommodation Request: Optional section for employees to request specific workplace accommodations
4. Vaccination Records: For roles where specific vaccinations are required (e.g., healthcare workers)
5. Physical Fitness Declaration: For roles requiring specific physical capabilities or fitness levels
1. Schedule A - Medical Conditions List: Comprehensive list of medical conditions that employees should declare if applicable
2. Schedule B - Privacy Policy: Detailed privacy policy specifically relating to health data processing
3. Schedule C - Occupational Health Requirements: Specific health requirements for different job roles within the organization
4. Appendix 1 - Guidance Notes: Explanatory notes helping employees understand how to complete the form
5. Appendix 2 - Medical Self-Assessment Guidelines: Guidelines to help employees assess their health status accurately
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Manufacturing
Construction
Education
Food Service
Transportation
Retail
Hospitality
Professional Services
Public Sector
Pharmaceuticals
Mining
Agriculture
Childcare
Aviation
Relevant Teams
Human Resources
Health and Safety
Occupational Health
Legal
Compliance
Risk Management
Employee Relations
Operations
Facilities Management
Medical Services
Relevant Roles
HR Manager
Health and Safety Officer
Occupational Health Nurse
Data Protection Officer
HR Director
Compliance Manager
Risk Management Officer
Employee Relations Manager
HR Administrator
Recruitment Manager
Operations Manager
Facility Manager
Legal Counsel
Company Doctor
Workplace Health Coordinator
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