Safer Together Booking Form "*" indicates required fields Type of request:*Fitness to work medical assessmentOther (Please outline in comments)Candidate name:* First Last Candidate date of birth:* DD slash MM slash YYYY Candidate email:* Candidate phone number:*Job title:*Contractor company email address (where fitness slip will be sent):*Preferred location for medical:*Worker required to conduct task?*More than one box can be checked for each worker Remote or isolated location work Wear tight-seal respiratory protective equipment Audiometry - Baseline then every 2 years Emergency response and rescue teamwork Crane operator and mobile equipment operators Driver Other (if selected, the employer must forward relevant documentation (e.g. job task analysis or job description) to the assessing health practitioner Documents Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 100 MB, Max. files: 5. Please upload any relevant documents. For Periodic Medicals please upload previous medical assessment documentationAdditional comments
