What is the pre-employment health questionnaire form template?
A pre-employment health questionnaire should help a new starter begin work safely and with the right support — not screen people out. This template is written that way. It opens with a plain note: answers go to the occupational health adviser, not the manager; the employer only learns whether the person is fit for the role and what adjustments are recommended; and a health condition doesn't by itself mean an offer is withdrawn.
The questions focus on the job. The new hire records the demands of their role — lifting, heights, driving, machinery, nights, lone working, patient care and exposures — then any relevant health conditions, current treatment, medication that affects alertness, recent health-related absence and workplace allergies. For care roles, a vaccination question appears. The support page asks directly whether adjustments might help and offers a call with occupational health before starting.
Completed questionnaires are saved as signed PDFs in the occupational health team's FileIt vault.
- Best for
- Occupational health providers and employers with an OH function
- Filled in by
- The new hire, after a job offer
- Time to complete
- About 8 minutes
- Includes
- Confidentiality note, role demands, condition checklist, adjustments request, three consents
Who uses a pre-employment health questionnaire form?
- Health clearance after a conditional job offer
- Healthcare and care roles needing vaccination checks
- Driving, machinery or safety-critical roles
- Night workers who are offered a health assessment
- Identifying adjustments before a disabled employee's first day
- Occupational health providers serving several client employers
Questions on this pre-employment health questionnaire form
27 questions over 4 pages · includes signature, conditional questions, multiple pages, consent checkbox.
1 About you & your role
- Name*
- Date of birth*
- Phone*
- Email*
- Job title*
- Department or site
- Start date
- Working pattern Days · Nights · Rotating shifts · Flexible
- Does the role involve any of these? Lifting or manual handling · Standing or walking most of the day · Working at height · Driving for work · Operating machinery · Night work · Working alone · Computer work most of the day · Food handling · Patient or client care · Noise, dust or chemicals
2 Your health
- Do you have, or have you had, any of the following?* Back, neck or joint problems · Heart or circulation condition · Asthma or other breathing condition · Diabetes · Epilepsy, seizures or blackouts · Mental health condition · Hearing difficulty · Sight difficulty (not corrected by glasses) · Skin condition such as dermatitis · Neurological condition · Other long-term condition · None of these
- Tell us about any condition you ticked
- Are you currently having treatment or waiting for treatment?
- What treatment? asked only when it applies
- Do you take medication that can cause drowsiness or affect concentration?
- Health-related time off work in the last two years None · Less than two weeks in total · Two weeks to three months · More than three months
- Allergies or sensitivities that could matter at work
- Vaccinations or immunity checks, if required for your role asked only when it applies
3 Support at work
- Do you think you might need any adjustments at work?* No · Yes · Not sure
- What would help? asked only when it applies
- Would you like to speak to the occupational health adviser before you start?
- Best time to call you asked only when it applies
- Doctor / GP name and practice
4 Declaration
- Accuracy*
- Further information*
- Sharing the outcome*
- Signature*
- Date*
The pre-employment health questionnaire form, page by page
1 About you & your role
A confidentiality note, then name, date of birth, phone, email, job title, department, start date and working pattern. A checklist of role demands — from lifting and working at height to driving, lone working, food handling, patient care and exposure to noise, dust or chemicals.
2 Your health
A checklist of conditions that can matter at work, with a free-text box for how they affect the person. Current or planned treatment, medication that causes drowsiness, health-related time off in the last two years and work-relevant allergies. Vaccination history appears for roles involving patient or client care.
3 Support at work
Whether adjustments might be needed — yes or not sure opens a box for what would help. The new hire can ask to speak to the adviser before starting and give a good time to call, and add their doctor's details.
4 Declaration
Three consents: the information is accurate; occupational health will ask separately before contacting their doctor; and the fitness outcome and recommended adjustments may be shared with the employer without medical details. Then a signature and date.
Make the template yours
- Tailor the role demands list to the jobs you recruit for
- Add role-specific questions, such as eyesight standards for drivers
- Change the vaccination question to your sector's requirements
- Route notifications only to the occupational health inbox
- Store responses in a restricted folder that managers can't see
- Have the wording checked against employment and data protection law where you operate
Tips for a better pre-employment health questionnaire form
- Send the questionnaire after a conditional offer, not during selection
- Keep the form and its answers separate from the personnel file
- Call anyone who says "not sure" about adjustments — they often need a conversation
- Give the employer an outcome, not a diagnosis
- Review adjustments again a few weeks after the start date
Every response becomes a PDF in your vault
The questionnaire is saved as a signed PDF in your FileIt vault and the occupational health team is emailed. The new hire can receive a copy.
Use the Responses table to see who needs a call or an assessment before their start date.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Pre-employment health questionnaire form: frequently asked questions
Is this pre-employment health questionnaire free?
Yes. It's included in FileIt's Forms app on every account, including the free plan.
Does the employer see the answers?
Only if you share them. The form tells respondents their answers go to occupational health, and you control who receives notifications and who can open the vault folder.
When should I send it?
Usually after a conditional job offer. Rules on health questions during recruitment vary by country, so check what applies to you.
Can new hires ask for adjustments?
Yes. A dedicated question asks whether adjustments might help and what they would be.
Does it include vaccination questions?
Only for roles where the new hire ticks patient or client care.
Do new hires need a FileIt account?
No. They fill it in from a link.