Application Pack

Do you suffer from blood pressure problems (high or low) that are not controlled by medication? *

Have you ever had a fit, faint, seizure or other interruption of consciousness? *

Do you suffer from any form of diabetes? *

Have you ever had any other sudden impairment of consciousness or any other sudden disabling condition? *

Have you ever suffered blackouts, unsteadiness, recurrent dizziness or any condition which may cause sudden collapse? *

Are you taking any medication that is giving you dizziness or drowsiness? *

Do you get discomfort or pain in the chest (angina) or shortness of breath on exercise? *

Do you suffer any health problems that render difficulty in moving rapidly over short distances on foot? *

Would you have difficulty in looking over either shoulder? *

Do you have difficulty with your eyesight or identifying colours (other than glasses)? *

Do you wear glasses or contact lenses? *

Do you have difficulty hearing normal conversation? *

Have you had any illness related to alcohol during the last 12 months? *

Have you used any drug of abuse (not alcohol or tobacco) within the last 12 months? *

Do you have vibration white finger? *

Have you worked with lead / asbestos? *

Have you had any chest related illness in the last 12 months? *

Have you had any back injuries in the last 12 months? *

Do You Wear Glasses? *

Do You Need To Wear Glasses To Reach The Required Standard? *

Do You Wear Contact Lenses? *

Do You Carry A Spare Pair Of Glasses At All Times When On Site? *