The Medical Declaration Form For Employees is a crucial document required in Philippine workplaces to ensure compliance with occupational health and safety regulations while protecting both employer and employee interests. This form is typically used during pre-employment, regular health assessments, or when returning to work after illness or injury. It collects essential health information in accordance with the Data Privacy Act of 2012, the Labor Code of the Philippines, and DOLE guidelines. The document helps organizations maintain a safe workplace while respecting employee privacy rights and medical confidentiality. It includes sections for general health status, medical history, current conditions, and any work-relevant health concerns, serving as a protective measure for both the organization and its employees.
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1. Employee Information: Basic details including name, employee ID, department, position, and contact information
2. General Health Declaration: Statement of current health status and any existing medical conditions that may affect work performance
3. Medical History: Declaration of relevant past medical conditions, surgeries, or hospitalizations that could impact current work capacity
4. Current Symptoms Declaration: Checklist of current symptoms or health concerns, particularly those that might be communicable
5. Emergency Contact Information: Details of persons to contact in case of medical emergencies
6. Data Privacy Notice: Statement explaining how medical information will be collected, used, stored, and protected in compliance with the Data Privacy Act
7. Certification and Authorization: Employee's certification that all information provided is true and correct, and authorization for verification
8. Signature Block: Space for employee signature, date, and witness signatures if required
1. COVID-19 Declaration: Specific declarations related to COVID-19 exposure, vaccination status, and symptoms - optional based on current public health requirements
2. Vaccination History: Details of relevant vaccinations - optional based on job requirements and workplace health policies
3. Travel History: Recent travel information - optional during disease outbreaks or for specific job roles
4. Lifestyle Declarations: Information about smoking, alcohol consumption, etc. - optional based on relevance to job role
5. Workplace Accommodation Requirements: Section for declaring any needed workplace accommodations due to medical conditions - optional based on company policy
6. Regular Medication Declaration: Information about regular medications that might affect work performance - optional based on job requirements
1. Schedule A - Symptom Checklist: Detailed checklist of specific symptoms for employee to mark
2. Schedule B - Medical Condition Codes: Reference list of standardized medical condition codes for use in the form
3. Schedule C - Privacy Policy: Detailed privacy policy regarding medical information handling
4. Appendix 1 - Employee Rights and Responsibilities: Document outlining employee rights regarding medical declarations and responsibilities for updating information
5. Appendix 2 - Company Medical Policy: Summary of relevant company medical policies and procedures
Authors
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Manufacturing
Education
Financial Services
Retail
Information Technology
Construction
Food Service
Transportation
Mining
Hospitality
Pharmaceutical
Agriculture
Government Services
Business Process Outsourcing
Relevant Teams
Human Resources
Occupational Health and Safety
Legal
Compliance
Risk Management
Employee Relations
Medical Services
Administration
Operations
Data Privacy Office
Relevant Roles
HR Manager
Occupational Health and Safety Officer
Medical Officer
Compliance Officer
Risk Manager
Data Privacy Officer
HR Business Partner
Recruitment Manager
Employee Relations Manager
Facilities Manager
Operations Manager
Legal Counsel
Health and Wellness Coordinator
Corporate Nurse
Administrative Officer
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