Medical Questionnaire
Guidance on Medical Questionnaire Policy
Independent schools vary widely in terms of their size, pupil
population, location, provision and practice. The attached document
is offered as guidance to help schools to prepare their own policy
in a way that suits their own circumstances and reflects the needs
of their own community. Remember, the following information is for
guidance only. Before using it, and particularly after adapting it,
schools should consult their own legal advisers.
Please note that, where an insertion is required, square
brackets are used without text or with suggested text. Other square
brackets indicate optional or alternative clauses.
The ISBA acknowledges the assistance provided by guidance
documents prepared by the following public bodies, charities and
not for profit organisations:
The Department for Children Schools and Families (DCSF)
The Department of Health (DH)
Medical Officers of Schools Association (MOSA)
The Independent Schools Inspectorate (ISI)
The Office for Standards in Education (OFSTED)
Teaching & Development Agency (TDA)March 2009
GUIDANCE ON MEDICAL QUESTIONNAIRE POLICYA Legal Requirement
& an ISI Reporting Standard,An OFSTED Reporting Standard for
Boarding Schools
References:
A: Health & Safety at Work Act 1974B: Management of Health
& Safety at Work Regulations 1992
C: Access to Medical Reports Act 1988
D: DfES Circular 4/99 Physical and Mental Fitness to Teach,
www.teachers.org.uk/resourcesE: The Education (Independent School
Standards) (England) Regulations 2003, SI2003/1910
F: ISI Regulatory Checklist (0907)
G: DH Guidance Boarding Schools: National Minimum Standards,
Inspection Regulations
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006331H:
Teaching & Development Agency Circular How to qualify as a
Teacher in England
www.tda.gov.ukI. Medical Officers of Schools (MOSA) Guidance
Documents (www.mosa.org.uk)
INTRODUCTION
Teachers must have the physical and mental capacity to teach, or
they pose a potential risk to the health and safety of pupils and
colleagues alike, (see references). ISI Reporting Standard 4
imposes a duty upon schools to carry out medical checks on its
prospective staff, alongside the other statutory pre-employment
checks. Schools are also required to maintain relevant health and
welfare information about their pupils, particularly their
boarders, in order that their individual health and welfare needs
can be met.CONTENTS OF POLICYPart 1: StaffThe first stage in the
process of carrying out a medical check on a prospective member of
staff is to invite them to complete a confidential questionnaire,
followed, in the case of teachers, by a medical examination by his
or her GP or the School Doctor. Schools may decide to adopt the
same procedure for some groups of non-teaching staff; but may
decide to restrict the procedure to completing a self-administered
questionnaire which can be scrutinised by a nurse or doctor.The
policy should be published on the staff part of the web site, or in
the staff handbook. The material given to all job applicants should
explicitly state that the completion of a medical questionnaire,
followed by a medical with the applicants GP (or the School Doctor)
forms an essential part of the pre-employment process for all
teaching [and non-teaching] posts in the school. Assurances should
be offered that it is not unlawful for disabled people to be
required to answer pre-employment medical questionnaires, because
the policy applies to all prospective employees and serves to
confirm their fitness for work, as well as identifying specific
problems.Part 2: Pupils
All parents who have accepted a place at the school will be
invited to complete a medical questionnaire on their son or
daughter. In addition, parents of boarders will be invited to
register their child with the School Doctor.RELATED POLICIES THAT
ARE REQUIRED OF SCHOOLS Policies Relating to the Appointment and
Checking of Staff at Independent Schools.
Drugs and Drug-testing Policy First Aid
Protocol for Administration of Medicines in Schools Alcohol and
the Management of Pupil Intoxicated with Alcohol
General Policy Statement for Health and Safety
PART 1: MODEL POLICY FOR STAFF[ ] School takes its child
protection and other legal responsibilities very seriously. Any
offer of appointment to a successful candidate will be conditional
upon the satisfactory completion of those pre-appointment checks
that are prescribed by the law. This includes a medical check which
confirms [a teachers mental and physical fitness to teach in
accordance with DfES Circular 4/99 (as subsequently amended)]/[a
candidates fitness to carry out the duties of the post for which
they are applying]
We are an equal opportunities employer and welcome applications
from all candidates. All our prospective employees are asked to
complete identical pre-employment questionnaires. All candidates
for teaching posts and for the following key non-teaching staff
posts [ ] are also asked to obtain a letter of medical clearance
either their own GP [or from the School Doctor] before their
appointment is finalised. Candidates [do no have to use the School
Doctor, and] should bear in mind that the law provides that they
must consent before a medical report can be obtained from their own
doctor for employment purposes, and that they are entitled to see
their report. (The school will meet any costs of the medical
examination).A sample of our confidential pre-employment
questionnaire is attached. All completed questionnaires are stored
securely in our Medical Centre. Access is restricted to the School
Doctor and the Nurse, who will advise the Head Master/Mistress on
the appropriateness of confirming the appointment. Thereafter, they
will form part of an employees medical records and will not be
disclosed to any third party. Medical records are securely
destroyed after an individual leaves the employment of the
school.SAMPLE CONFIDENTIAL MEDICAL QUESTIONNAIRE FOR STAFF
TITLE:SURNAME:FIRST NAMES:
ADDRESS:
TEL.NO:
MOBILE:
E-MAIL:DATE OF BIRTH:
AGE:
SEX:
Post for which you are applying:
Name and Address of your GP:
Tel.No:
Please describe your present state of health:
Have you consulted a Doctor in the last 12 months? If so, please
give the reason:
Are you waiting for an operation or any medical investigation?
If so, please give details:
How many days absence through sickness have you had in the last
12 months?
Are you (or have you been) registered as disabled? YES/NO
If so, please give: Card No: Expiry Date:
Are there any special adjustments that you would require in
order to work at the school?
If so, please describe them.
Do you receive a disability pension? YES?NO
Have you ever:1. Had an operation?
2. Been seriously ill or injured?
3. Received in-patient treatment for a physical or mental
condition?
4. Been refused, or lost your employment for health reasons?
5. Been made ill by your work?
6. Been refused a drivers licence on grounds of ill health?
7. Have you ever suffered from any mental, psychological or
psychiatric problem?
8. Have you ever been treated for TB?
NoYesPlease give details
Do you suffer from or have ever had:Diabetes YES/NO Skin
rashes/eczema YES/NO Swelling of legs/ankles YES/NO
High Blood Pressure YES/NO Anaemia YES/NO Period or prostate
problems YES/NO
Asthma YES/NO Varicose veins YES/NO Migraines/ frequent
headaches YES/NOCough (frequent) YES/NO Heart problems YES/NO
Rupture YES/NORheumatic fever YES/NO Chest problems YES/NO Back
problems YES/NO
Arthritis YES/NO Fainting or dizziness YES/NO Ear trouble
YES/NO
Epilepsy/fits YES/NO Hay Fever YES/NO Eye trouble YES/NO
Shortness of breath YES/NO Jaundice YES/NO Nerve trouble
YES/NO
Stomach trouble YES/NO Joint trouble YES/NO
If you have answered yes to any of the above, please provide
details:
(Continue on a separate sheet if necessary)
Please give details of any allergies
Are you on any medication at present?
Have you ever worked in a dusty trade? YES/NO
Do you need glasses to read? YES/NO
Have you ever had a head injury? YES/NO
Do you suffer from any other medical problems not covered
above?
DECLARATIONTo the best of my knowledge and belief the
information given above is true. I understand that giving false
information or failing to disclose significant information could
result in the termination of my contract. I confirm that the school
may approach my GP to seek information about any medical condition
that may restrict my ability to undertake this appointment. I
confirm that I am willing to undergo a pre-employment medical
examination with my GP/the School Doctor.
Signed: ______________________________ Date:
___________________
Name:_________________________________
(Please print)
PART 2: MODEL POLICY FOR PUPILS AT DAY SCHOOLSTHE MEDICAL
CENTRE
We have a [modern, purpose built] Medical Centre/ Medical Room
at [ ] School, led by [ ] and [her] team]. [She is /They are]
responsible for any medical care or first aid that your child may
require during the school day, or at other times when the school is
open. Dr [ ], the School Medical Advisor, holds [twice weekly
morning] surgeries.
There is a qualified nurse on duty in the Medical Centre from
[08.00am to 5.00pm every day] who is available to administer first
aid, to deal with any accidents or emergencies, or if someone is
taken ill.
MEDICAL CARE
Although your son and daughter will normally receive medical
care from your family GP practice; we hold medical information on
all our pupils in order to ensure that we can provide appropriately
for their needs, or look after them if they are injured or have an
accident. We would therefore be grateful if you would complete and
return the medical questionnaire enclosed with this document before
he or she joins the school.MEDICAL EXAMINATION AND
IMMUNISATIONSDuring their first term, all new pupils will receive a
medical examination from the School Medical Advisor. Your consent
will be sought from time to time to your child receiving the
routine range of immunisations recommended by the Department of
Health for all children of his or her age. MEDICAL RECORDSWe keep
records of all treatment and immunisations that your child receives
during his or her time at the school. We also record all accidents
and injuries to your child. Access to these records is restricted
to the Medical Staff.
All medical records will be stored in the Medical Centre until
your son/daughters 25th birthday, when they will be securely
destroyed.
IF YOUR CHILD BECOMES ILL
We will always contact you if your child suffers anything more
than a trivial injury, or if he or she becomes unwell during school
day, or if we have any worries or concerns about his or her health.
We will ask you to collect your child if he or she becomes ill
during the school day.
EMERGENCY MEDICAL TREATMENT
However, in accepting a place at the school, we require parents
to authorise the Head Master/Mistress, or an authorised deputy
acting on his/her behalf, to consent on the advice of an
appropriately qualified medical specialist to your child receiving
emergency medical treatment, including general anaesthetic and
surgical procedure under the NHS, if we are unable to contact you
in time.
MEDICINES AND TREATMENTS BROUGHT TO SCHOOL BY PUPILS
Please advise the [School Nurse] of any medication that your
child has brought into school. If your [son/daughter] has a medical
condition which necessitates regular access to medication, please
inform the Pastoral Staff, so that an appropriate regime can be
devised. The relevant academic and pastoral staff will be informed,
in confidence, of any condition that is likely to affect him/her in
any area of school life.
MEDICAL QUESTIONNAIRE
Parents of new pupils are requested to complete and return the
enclosed questionnaire to [ ] at the School Medical
Centre._________________________________________________________________________PART
3 MODEL POLICY FOR PUPILS AT BOARDING SCHOOLSTHE MEDICAL CENTREWe
have a [modern, purpose built] Medical Centre at [ ] School, led by
[ ] and [her] team. Dr [ ] is the School Medical Advisor. They are
responsible for the medical care of your child whilst [he or she]
is a pupil at the school.There is a qualified nurse on duty in the
Medical Centre 24 hours a day who is available to administer first
aid, to deal with any accidents or emergencies, or if someone is
taken ill. The School Medical Adviser holds surgeries at the
following times:[ ]
MEDICAL CARE
[All our boarders need to be registered with [Dr ], the School
Medical Adviser. Please send your son or daughters National Health
Service Medical card (or, if he or she does not have an NHS card,
NHS form GMS1, which may be downloaded from the internet) to [ ] at
the Medical Centre, together with the completed questionnaire
enclosed with this document. Pupils who are not entitled to NHS
treatment are advised to obtain private medical insurance cover
[details of which are sent to all new parents].
MEDICAL EXAMINATION AND IMMUNISATIONSDuring their first term,
all new pupils will receive a medical examination from the School
Medical Advisor. Your consent will be sought from time to time to
your child receiving the routine range of immunisations recommended
by the Department of Health for all children of his or her age. [We
also offer all our pupils annual immunisation against flu, subject
to your consent].MEDICAL RECORDSThe NHS records of pupils who are
registered with Dr [ ] are stored securely in the Medical Centre.
We also keep records of all treatment and immunisations that your
child receives during [his or her] time at the school. We also
record all accidents and injuries to your child. Access to medical
records is restricted to the Medical Staff.Your son/daughters NHS
records will automatically transfer to his/her new doctor on
leaving the school. Any other medical records relating to your
child will be stored in the Medical Centre until your son/daughters
25th birthday, when they will be securely destroyed.
EMERGENCY MEDICAL TREATMENT
We will always contact you if your child suffers anything more
than a trivial injury, or if [he or she] becomes unwell, or if we
have any worries or concerns about [his or her] health.
However, in accepting a place at the school, we require parents
to authorise the Head Master/Mistress, or an authorised deputy
acting on his/her behalf, to consent on the advice of an
appropriately qualified medical specialist to your child receiving
emergency medical treatment, including general anaesthetic and
surgical procedure under the NHS, if we are unable to contact you
in time. [If your child is not entitled to receive NHS treatment,
we require parents to authorise the Head Master/Mistress, or an
authorised deputy acting on his/her behalf, to consent on the
advice of an appropriately qualified medical specialist to your
child receiving privately arranged emergency medical treatment,
including general anaesthetic and surgical procedure at your
expense.]MEDICAL TREATMENT RECEIVED DURING THE HOLIDAYS
Please inform the Medical Centre at the start of term if your
child received any significant medical treatment or any
immunisations during the holidaysMEDICINES AND TREATMENTS BROUGHT
TO SCHOOL BY PUPILS
Please advise the [School Nurse]/[Matron] of any medication that
your child has brought into school. If your [son/daughter] has a
medical condition which necessitates regular access to medication,
please inform [his/her] House Master/Mistress, so that an
appropriate regime can be devised. The relevant academic and
pastoral staff will be informed, in confidence, of any condition
that is likely to affect him/her in any area of school life.MEDICAL
QUESTIONNAIRE
Parents of new pupils are requested to complete and return the
enclosed questionnaire to [ ] at the School Medical Centre.SAMPLE
MODEL MEDICAL QUESTIONNAIRE FOR PARENTS OF NEW PUPILS
SURNAME: FIRST NAMES:
DATE OF BIRTH: YEAR OF ENTRY TO [ ] SCHOOL:RECORD OF
IMMUNISATIONS:
TYPEDATE
Diptheria,tetanus,whooping cough, polio
Haemophilius influenza type B (Hib)
Pneumoccoccal infection
Meningitis C
Measles, Mumps, rubella
(Girls only) Cervical cancer
Heaf Test
BCG
PLEASE GIVE DETAILS OF THE FOLLOWING
Any allergies or sensitivities to food, medication, pets or to
insect stings:
Any chronic or recurring medical conditions needing regular or
occasional medication or treatment:
History of any serious illnesses or injuries requiring admission
to hospital:
Any other conditions that might affect your child in his or her
school life:
Are there any psychological factors that affect your child of
which we should be aware?
Does your child have regular dental checks?
Does he/she wear a dental appliance?
(Boarders only) Does the school need to organise any dental
appointments?
Does your child have regular eye tests?
Does your child require glasses?
(Boarders only) Does the school need to organise any optician
appointments?
Do you have private medical insurance?
(Day pupils only) The name, address and telephone number of your
childs GP:
(Boarders only) I enclose my childs NHS card/ NHS Form GMS1 in
order that my child can be registered with the School Medical
Adviser, Dr [ ]
PEASE COMPLETE THE FOLLOWING SECTION
CONSENT TO EMERGENCY TREATMENTI/ We authorise the Head
Master/Mistress, or an authorised deputy acting on his/her behalf
to consent on the advice of an appropriately qualified medical
specialist to my/our child receiving emergency medical treatment,
including general anaesthetic and surgical procedure [under the
NHS]/[privately, either at our expense, or under our private
medical insurance cover] if the school is unable to contact me/us
time.
Signature of both parents: ___________________
______________________
or GuardianDate: _____________
CONSENT TO GENERAL TREATMENT AND TO FIRST AID
I/We give consent for my/our child receiving all the general
health care and first aid services provided at the School under the
supervision of the School Medical Adviser and the qualified School
Nurse.He/she may/ may not be given first aid treatment by any
qualified member of staff.
He/she may/may not be given non-prescribed medicines to treat
minor illness or injury.
I/We would like/do not want to be informed about every
medication given.
Signature of both parents: ___________________
______________________
or GuardianDate: _____________
PAGE 10ISBA March 2009
