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Night Medical Questionnaire

Your employer has highlighted you as someone who currently undertakes night working, or looking to undertake night work in the near future. Under the Working Time Regulations, all night workers are to be offered an initial and an annual health assessment. A night worker is classified as an individual who regularly works for more than three hours during the period 11 p.m. to 6 a.m. The assessment is voluntary and additional to any other health assessment undertaken

Should any areas of your answers raise concerns, we will contact you to discuss this further. 

Data Protection Information

The information that you supply on this questionnaire will be held in confidence by Motor Medicals Ltd & Work Site Medicals as part of your occupational health record. For full details of how your personal information is used by us, please see &

Please Note- No information will be shared with any 3rd parties. 

The following medical conditions could possibly affect your health and ability to safely carry out night work, or could be made worse by night work.

Do you suffer from any of these conditions?