Appointed doctor forms

General

FODMS32 - Certificate of appointment as appointed doctor (not available online)
FODMS38 - Application to be appointed as an appointed doctor under regulations^[1]
FODMS38R - Renewal of appointment as an appointed doctor ^[2]

Ionising radiation

F2067 - Health record (PDF) ^[3]
FODMS101 - Clinical record (PDF) ^[4]

Lead

Asbestos

FODMS72A - Certificate of Medical examination (not available online – contact HSE Headquarters^[10])
FODMS75 - Medical Surveillance Questionnaire and Consent Form (PDF) ^[11]
FODMS75 - Guidance on completing the form (PDF) ^[12]
FODMS75 - Reference list (PDF) ^[13]
FODMS75 - Information leaflet for people working with asbestos (PDF) ^[14]
FODMS75 - Address label (PDF) ^[15]
FODMS100 - Health surveillance record form (PDF) ^[16]
Respiratory symptom questionnaire - licensed work with asbestos - Form MSLW1 - PDF version (PDF) ^[17]

Link URLs in this page

FODMS38 - Application to be appointed as an appointed doctor under regulationshttps://www.hse.gov.uk/forms/health/fodms38.dotx
FODMS38R - Renewal of appointment as an appointed doctor https://www.hse.gov.uk/forms/health/fodms38r.dotx
F2067 - Health recordhttps://www.hse.gov.uk/forms/health/f2067.pdf
FODMS101 - Clinical recordhttps://www.hse.gov.uk/forms/health/fodms101.pdf
FODMS98 - Initial medical assessmenthttps://www.hse.gov.uk/forms/health/fodms98.pdf
FODMS99 - Surveillance record for person exposed to leadhttps://www.hse.gov.uk/forms/health/fodms99.pdf
FODMS102 - Notification to employer of biological test results and record of medical surveillancehttps://www.hse.gov.uk/forms/health/fodms102.pdf
FODMS103 - Certificate of unfitness/fitnesshttps://www.hse.gov.uk/forms/health/fodms103.pdf
Blood lead return of workers under medical surveillancehttps://www.hse.gov.uk/forms/health/blood-lead-return.xlsx
contact HSE Headquartershttps://www.hse.gov.uk/doctors/contact.htm
FODMS75 - Medical Surveillance Questionnaire and Consent Formhttps://www.hse.gov.uk/forms/health/fodms75.pdf
FODMS75 - Guidance on completing the formhttps://www.hse.gov.uk/forms/health/fodms75-guidance.pdf
FODMS75 - Reference listhttps://www.hse.gov.uk/forms/health/fodms75-reference.pdf
FODMS75 - Information leaflet for people working with asbestoshttps://www.hse.gov.uk/forms/health/fodms75-information.pdf
FODMS75 - Address labelhttps://www.hse.gov.uk/forms/health/ms75-address-label.pdf
FODMS100 - Health surveillance record formhttps://www.hse.gov.uk/forms/health/fodms100.pdf
Respiratory symptom questionnaire - licensed work with asbestos - Form MSLW1 - PDF versionhttps://www.hse.gov.uk/asbestos/assets/docs/mslw1-licensed.pdf
List of appointed doctorshttps://www.hse.gov.uk/doctors/assets/docs/current-appointed-doctors.xlsx
Appointed doctors formshttps://www.hse.gov.uk/doctors/forms.htm
Diving medical requirementshttps://www.hse.gov.uk/diving/medical-requirements.htm
List of Appointed Doctorshttps://www.hse.gov.uk/doctors/assets/docs/current-appointed-doctors.xlsx
List of laboratories for blood lead analyseshttps://www.hse.gov.uk/lead/surveillance.htm