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If you have any difficulty completing this questionnaire online, you can also download a printable version. There are two parts - Work Health Assessment and Immunisation Report. These forms are also available from the placements office.

Confidential Health Questionnaire for Students

Guidance for completion of health questionnaire

Congratulations on receiving an offer of a place to undertake your course at University of Portsmouth.

Please read this guidance before completing the questionnaire located at the bottom of this page.

University of Portsmouth is obliged to ensure that students have good health to manage the rigours of the course, to study and work safely in a clinical environment and maintain professional standards of conduct and behaviour. (See: HCPC Standards of Proficiency)

Poor health may put patients, service users and/or colleagues at risk by transfer of infection or because of ill-judgment or impaired performance. All students are therefore asked to complete an initial health screening procedure using this confidential written health questionnaire. As a student, undertaking a placement, you are likely to be exposed to a number of infectious diseases. Information about your immunity status to common infectious diseases is requested so please ensure you include this information on the attached form, from your General Practitioner (GP).

The purpose of the questionnaire is to see whether you have any health problems that could affect your ability to undertake your chosen course or place you at any risk in the workplace during placements.

You should provide as much detail as possible about any ongoing health concerns which will enable the Occupational Health Practitioners to assess your fitness and to make any recommendations to support you in your studies.

Having a health condition, an illness or impairment will not prevent a student from entering placement, provided that adjustments or modifications can enable the student to achieve the necessary competencies of knowledge, skills and behaviour required for the course. You are therefore actively encouraged to disclose such information.

An Occupational Health Nurse Adviser may contact you for further information by telephone or request that you attend the Occupational Health Department for a consultation with either an Occupational Health Nurse Adviser or Physician.

The Science Faculty Placement Office will be advised of your fitness status. Your answers to this questionnaire will be confidential to the Occupational Health team and will not be given to anyone else without your permission. Any personal or sensitive information will not be disclosed to third parties without your express consent unless it is deemed in the public interest.

Immunisation report

Please download the immunisation report, print it out and arrange for your registered GP to complete it.

Once you have obtained this immunisation report from your GP, please send it to Occupational Health at the address, email or fax number below:

Email: occhealth.admin@porthosp.nhs.uk

Fax: +44 (0)23 9228 6739

Tel: +44 (0)23 9228 3352

Occupational Health Department
Queen Alexandra Hospital
Southwick Hill Road
United Kingdom

Please note that you must obtain this information before you commence your placement.

If you have been unable to obtain evidence from your GP you will be offered an appointment with Occupational Health to have the relevant vaccinations or blood tests to complete this requirement for placement.

Opening date

This questionnaire and immunisation report need to be completed and submitted between:

  • 1st July and 31st August for courses starting in September.
  • 1st December and 31st January for courses starting in February.

We cannot accept any documentation prior to the opening date.