The Statement Of Health Form For Employment serves as a crucial tool for employers to assess an individual's ability to safely perform essential job functions while maintaining compliance with U.S. federal and state regulations. This document is typically used after a conditional job offer has been made or when specific job requirements necessitate health-related information. It must be carefully structured to include only job-relevant health questions while avoiding discriminatory inquiries prohibited by the ADA, GINA, and other applicable laws. The form helps establish clear documentation of health-related capabilities while protecting both employer and employee interests.
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1. Personal Information: Basic identifying information of the employee including name, contact details, and position applied for
2. Position Information: Details about the job title and essential functions of the position that relate to health requirements
3. General Health Declaration: Basic health status relevant to job functions, carefully worded to comply with ADA requirements
4. Certification: Employee's confirmation that all provided information is truthful and complete
5. Privacy Notice: Information about how health data will be used, protected, and stored in compliance with HIPAA and privacy laws
1. Specific Physical Requirements: Section for positions with specific physical demands, including lifting requirements, standing duration, or other physical activities
2. Environmental Conditions: Health considerations related to specific work environments such as outdoor work, exposure to chemicals, or extreme temperatures
3. Emergency Contact Information: Optional section for emergency contact details, typically included for high-risk positions or when required by company policy
1. Job Description Appendix: Detailed description of physical requirements and essential functions of the position
2. Medical Provider Form: Supplementary form for healthcare provider to complete if medical certification is required post-offer
3. ADA Notice: Appendix containing detailed information about employee rights under the Americans with Disabilities Act
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