Personal Information
General
Allergies
Joint and Muscle Health
The position you have applied for may require you to perform tasks involving the following:
Moving patients or heavy objects
Prolonged standing or sitting
Pushing, pulling, reaching
Bending
Calming and Restraint
Repetition of any of the above
Mental Health/Wellbeing
Infectious Materials
NB: Cleaners, orderlies, ward clerks and security will either have face to face contact or handle waste material
Biological Screening
This Section is for candidates who will have contact with patient and/or infectious material.
If you have proof of immunity (vaccination records) and/or test results for the following please submit them with your application by attaching them in the next section:
- Hepatitis B
- Varicella (Chicken Pox)
- Measles
- Mumps
- Rubella
- TB Blood test (Quantiferon TB Gold) or 2 Step Mantoux tests or Heaf tests
- Chest X-Ray report (If you have had a positive Mantoux/Heaf/TB blood test previously)
- MRSA results less than 2 months old
Copies of any of the above can also be scanned and emailed to peshq@adhb.govt.nz or faxed to +64 9 630-9759
Please note that any testing that will be required may delay the clearance process
Smoke Free Policy
Auckland DHB has a Smoke Free Policy which prohibits staff and visitors from smoking anywhere in its facilities or grounds.
If you smoke and wish to receive assistance, a Smoking Cessation Programme is available to all staff at Auckland DHB.
Contact the Smokefree Service by: Internal Voice message Dial: 27867; External Voice message: Dial 0800 667 833; Text: 0273267334 or by email smokefree@adhb.govt.nz
Privacy
Other Supporting Files
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Privacy and Declaration Statement
I declare that the answers I have provided in this application are complete and accurate. I understand that giving false or misleading information or suppressing information may result in me not being appointed or, if I am employed, my employment may be terminated by Auckland DHB.
- I understand the collection, use and disclosure of my personal information will comply with relevant legislation
- I understand that my personal and health information will be placed on my confidential Occupational Health file
- I consent to the Occupational Health Service accessing health information relevant to my pre-employment health screening process from my electronic health records, prior Occupational Health units, my educational institute, ACC and my healthcare provider
- If required, I agree to undertake further health assessment with Occupational Health or an external health professional(s) on behalf of the Occupational Health Service
- I understand only relevant information about my fitness for work, work safety, immunity status and need for any work accommodations to keep me and others safe in the workplace may be made available to Auckland DHB
- I understand I have a right to access this information and to obtain copies of my test results
- I understand Auckland DHB may request the Occupational Health Service provide them information about my work capacity and any failure to accurately disclose pre-existing health conditions where this is deemed necessary for the purpose of an HR process, an investigation, or subsequent request for health assessment(s)
- I agree that the Auckland DHB Occupational Health Service may disclose information to my General Practitioner and to other DHB Occupational Health services relating to pre-employment health screening, infectious disease contact tracing, and health monitoring
- If I am a clinician, I understand that I must consider my own risk of infection with blood-borne pathogens (including Hepatitis B, Hepatitis C and HIV) and the associated risk of transmitting infection to patients. I have reviewed relevant statements from my professional body (e.g. NZMC, NZNO, RACS, NZMA). I understand that any employee who is a carrier of a blood-borne disease and knowingly exposes their patients to a risk of infection without seeking personal specialist clinical advice, could be open to disciplinary proceedings.
- I understand that transmission of health information via email is convenient but may not be secure. I accept this risk and consent for health information to be sent to via email.
(full name)