Medical History and Declaration

Do you, or have you ever, had any of the following conditions?

Please disclose any condition which has the potential to affect your ability to carry out your onsite duties safely; without affecting the safety of others on site.

If your answer is yes to any please provide full details.




























I declare that the information I have given is true and correct and I consent to this data being held on a computer or in a manual filing system in accordance with the confidentiality requirements of the Data Protection Act 1998.




Emergency Contact






Proof of Eligibility to Work in the UK

List AList B
  • A passport showing the holder is a British Citizen, or have the right of abode in the UK.
  • A document showing that the holder is a national of European Economic Area country or Switzerland. This must be a national passport or identity card.
  • A residence permit issued by the UK showing that the holder is a national of an EEA country or of Switzerland.
  • A passport or other document issued by the Home Office which has an endorsement stating that the holder has a current right of residence in the UK as the family member of a national of an EEA country or of Switzerland.
  • A passport or other travel document endorsed to show that the holder can stay indefinitely in the UK, or have no time limit on their stay.
  • A passport or other travel document endorsed to show that the holder can stay in the United Kingdom; and that this endorsement allows the holder to do the type of work the employer is offering if they do not have a work permit.
  • An Application Registration Card issued by the Home Office to an asylum seeker stating that the holder is permitted to take employment.

A document giving a person's permanent National Insurance number and name. This could be a: P45, P60, National Insurance card, or a letter from a Government agency.

AND one of the following documents

  • A full birth certificate issued in the United Kingdom, which includes the names of the holder's parents or
  • A birth certificate issued in the Channel Islands, the Isle of Man or Ireland or
  • A certificate of registration or naturalisation stating that the holder is a British citizen or
  • A letter issued by the Home Office which indicates that the person named in it can stay indefinitely in the United Kingdom or has no time limit on their stay or
  • An immigration Status Document issued by the Home Office with an endorsement indicating that the person named in it can stay indefinitely in the United Kingdom or has no time limit on their stay or
  • A letter issued by the Home Office which indicates that the person named in it can stay in the United Kingdom; and this allows them to do the type of work that the employer is offering or
  • An Immigration Status Document issued by the Home Office with an endorsement indicating that the person named in it can stay in the United Kingdom; and this allows them to do the type of work that the employer is offering.

Or

  • A work permit or other approval to take employment that has been issued by Work Permits UK

AND one of the following documents

  • A passport or other travel document endorsed to show that the holder is able to stay in the United Kingdom and can take the work permit employment in question or
  • A letter issued by the Home Office confirming that the person named in it is able to stay in the United Kingdom and can take the work permit employment in question.