Night Worker Assessment

The purpose of this questionnaire is to ensure that you are suited to working at night. All the information you provide will be kept confidential




Do you suffer from any of the following
Diabetes *
Heart or circulatory disorders *
Stomach or intestinal disorders *
Difficulty with sleeping *
Chronic chest disorders *
A condition requiring medication to a strict timetable *
Any other health factors that might affect fitness to work *


I (named above), conform that the above is correct to the best of my knowledge.
Your signature *
Document Version: 1.2
Last reviewed: 14/08/2023
Reviewed by: Kristian H