Confined Space Surveillance Medical Form - Paper Version

Working in confined spaces can cause problems for employees with certain medical conditions. As regulations place a duty of care on employers when exposed to specific working conditions, the confined space medical is designed to lower the risk.

This form is comprised of 2 parts. Part 1 is to be completed by the employee and part 2 can be completed by the employees GP after examination. The form does focus on the relevant examinations and therefore prevents unnecessary additional ones.
Should problems be highlighted the form can be forwarded to the address provided on the form for assessment by an experienced Occupational Physician. A fitness certificate will be provided after the assessment.

The form can be used more than once within your company and does not include costs for the medical assessment and certificate.

Price: net £10.00; VAT £1.75; gross £11.75