Food Handler - Induction Step 1 of 6 - Your details 16% Your detailsThis form is used by the Company to assist in assessing your fitness for employment. The information will be kept entirely confidential and is needed to ensure the safety of you and others. Any points of uncertainty can be discussed with HR. Disease or disability will not necessarily preclude you from being employed so long as you can perform your duties and responsibilities without risk to yourself and/or other colleagues. If applicable this questionnaire will also be used to assess your fitness to work nights. All the information about you provided will be kept confidential. You may be required to attend a medical examination at the Company’s expense. Name* First Last Phone*Date of birth Day Month Year GenderMaleFemaleHeight Weight Address* Street Address Address Line 2 City County Post Code Name and address of GP Street Address Address Line 2 City County Post Code Medical HistoryHave you ever suffered from the following:Asthma and/or Hayfever Yes No Back, Neck or Joint Problems Yes No Chest/Respiratory Problems Yes No Epilepsy, Fits, Faints or Blackouts Yes No Diabetes Yes No Skin Problems Yes No Heart Disease or High Blood Pressure Yes No Mental Health Problems Yes No Hernia/Rupture Yes No Varicose Veins Yes No Kidney/Bladder Problems Yes No Stomach or Bowel Problems Yes No Circulation Problems or Blood Disorders Yes No As you said you suffer/have suffered with a condition above, could you please give more details:Do you have any current or past visual impairments (excluding glasses/lenses)? Yes No Please provide further details:Do you have poor hearing in either ear? Yes No Please provide further details:Are you currently taking any medication or receiving any medical treatment? Yes No Please provide further details:Have you ever been off work for more than two weeks due to a health/medical reason? Yes No Please provide further details:Do you have any recurrent health issue which causes occasional days off work? Yes No Please provide further details:Do you have any conditions or health issues not noted or that you would prefer not to discuss with Sun Valley HR personnel? Yes No Please provide further details: Food Handling QuestionnaireDo you suffer, or have you suffered from any of the following; Typhoid Fever or Paratyphoid Fever, Dysentery or Salmonella? Yes No Please provide further details:Have you ever had, or been in close contact with anyone known to have Tuberculosis? Yes No Please provide further details:Have you suffered from Diarrhoea, vomiting or any other stomach disorders within the last four weeks? Yes No Please provide further details:Do you have any problems with your bowels, e.g. Colitis, Irritable Bowel Syndrome, Crohns Disease or recurrent Diarrhoea? Yes No Please provide further details:Any recurrent chest infections, with the production of phlegm? Yes No Please provide further details:Any recurrent eye, ear, throat or mouth infections? Yes No Please provide further details:Have you travelled outside the European Union in the past four weeks? Yes No Please provide further details:Did you suffer from sickness, diarrhoea or stomach disorders whilst you were away or since your return? Yes No Please provide further details:Have you ever worked in a noisy environment where you had to shout to make yourself heard? Yes No Please provide further details:Have you ever worked in a dusty environment where dust masks were required? Yes No Please provide further details:Have you ever worked with power tools or other vibratory equipment? Yes No Please provide further details:Has a previous job role required repetitive hand, wrist or finger movement? Yes No Please provide further details:Are you currently suffering from a heavy cold? Yes No Please provide further details:Do you currently have any cuts or sores? Yes No Please provide further details:Are you or have you had any allergic reaction to peanuts or nut products? Yes No Please provide further details:Do you have any difficulties wearing personal protective equipment? E.g. gloves, safety glasses, footwear, ear protection etc? Yes No Please provide further details:Do you have any personal or health problems that could affect: - Working in a hot or cold environment - Standing for long periods - Tasks that involve pushing, pulling, lifting, or handling of loads - Climbing stairs - Understanding information - Working at heights Yes No Please provide further details: Night Worker QuestionnaireDo you suffer from any of the following:Diabetes Yes No Heart or circulatory disorders Yes No Stomach or intestinal disorders Yes No Any condition which causes difficulty sleeping Yes No Chronic chest disorders (especially if night time symptoms are troublesome) Yes No Any medical condition that requires medication to a strict timetable Yes No Any other health factors Yes No Have you ever suffered any health problems directly to working nights? Yes No As you said you suffer/have suffered with a condition above, could you please give more details: ConfirmationConsent All information provided is accurate to the best of my knowledge. I agree to notify Sun Valley of any changes to my medical situation to allow for any reasonable adjustments to be made.Please sign to confirm you agree with the above statement*Date completed Day Month Year Verification by Agency representativeHiddenAgency representative First Last HiddenAgency representative signatureHiddenDate MM slash DD slash YYYY Sun Valley Ltd Induction Sign OffThis induction is aimed at providing a brief introduction to the Company and is for all newly appointed personnel and agency workers. Please confirm which sections you have completed.WelcomeIntroduction to Sun Valley Yes No Health & SafetyHealth & Safety Policy Yes No Accident Yes No First Aid Yes No P.P.E Yes No Fire/Emergency Evacuation Yes No No Smoking Policy Yes No Drugs & Alcohol Yes No Machinery & Tool Safety Yes No On Site Hazards Yes No Warehouses Yes No FLT Yes No Manual Handling (Video) Yes No Mind The Stairs Yes No Site Pedestrian Walk Ways Yes No Chemicals Yes No Working at Heights Yes No Work Environment & Hazards Yes No An Introduction to Food SafetyAllergens Yes No Food Safety Yes No HACCP Yes No Quality Policy Yes No Factory Colour Coding Yes No Clean Hands Yes No Reporting Pests Yes No Reporting Illness Yes No Personal Hygiene Yes No Jewellery Yes No The Rules Yes No House Keeping Yes No FacilitiesWelfare Facilities Yes No Confirmation I have been briefed on all the above items and have understood the requirements of the Company. I shall undertake to fully comply with these requirements as a worker within the Company.Please sign to confirm you agree with the above statement*Date completed Day Month Year Verification by Agency representativeHiddenAgency representative First Last HiddenAgency representative signatureHiddenDate Month Day Year PhoneThis field is for validation purposes and should be left unchanged.