School Occupational-Health Professional Input Record

Enter the full legal or operating name of the school.

Select the applicable school type.

Identify whether the record concerns a new or revised health-surveillance scheme.

Enter the name of the occupational-health professional who provided the input.

For example, occupational physician, occupational-health nurse or occupational hygienist.

Enter the organisation, practice or service with which the professional is associated.

Provide an email address, telephone number or other work contact route.

Select all relevant bases and record supporting details in the next field.

Summarise relevant qualifications, registration, experience and any checks or information considered by the school.

Enter the number of completed years of relevant experience, if known.

Enter the date on which the advice, review or scheme-design input was provided.

Select all methods used for the professional input.

Describe the work activities, hazards, staff groups, exposures, proposed surveillance or other matters considered.

Record the professional's advice, recommendations, limitations, assumptions and any matters requiring further review.

Select all arrangements that apply, and describe the details in the next field.

Describe the agreed or proposed arrangements, responsible roles, implementation actions and any conditions or outstanding decisions. Do not include unnecessary personal medical information.

Enter the planned date for reviewing the advice or arrangements, if one has been set.

Enter the name and role of the person responsible for maintaining this record.

Confirm that the record accurately reflects the professional input and the arrangements recorded.

• Tick when complete