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Health Questionnaire

Medical History

Please provide information on matters relating to your health in relation to your application for employment with Consolidated Pastoral Company Pty Ltd.

A health condition, disability or injury is not a barrier to the consideration of your application for employment. The purpose of the assessment is to ensure that you are fit and safe to perform the proposed duties.

You should note that our properties are located in remote areas where access to medical facilities is limited. You may also be required to work with animals, on heavy machinery or in unfavourable outdoor climatic conditions.

You are assured that all information disclosed on this form is strictly private and confidential.
1. Personal Details
This question requires a valid number format.
This question requires a valid number format.
This question requires a valid number format.
2. Have you ever suffered from Asthma, used inhaler medication or been troubled with shortness of breath? *This question is required.
3. Do you have diabetes or raised blood sugar levels? If yes, please clarify what type of diabetes you have i.e. type 1 or 2 in the comments section. *This question is required.
4. Have you ever had or sought treatment for epilepsy, experienced fits, seizures, convulsions, fainting or black-outs? *This question is required.
5. Have you ever suffered from or experienced cases of heat exhaustion or sun stroke? *This question is required.
6. Have you sought treatment or taken medication for heart disease, heart murmur chest pain, irregular heartbeat or angina? *This question is required.
7. Have you ever had any sporting or recreational injuries that have lead you to see a GP, physiotherapist, masseuse or chiropractor? *This question is required.
8. Have you ever claimed workers compensation for a work place injury or illness? *This question is required.
9. Have you ever had an illness or injury requiring more than 3 days off regular work? *This question is required.
10. In the past two (2) years have you suffered from migraines or persistent headaches? *This question is required.
11. Have you ever consulted a counsellor, psychiatrist or psychologist? *This question is required.
12. Have you ever suffered from mental illness, depression, anxiety, panic attacks or stress? *This question is required.
13. Have you ever attempted self-harm? *This question is required.
14. Have you ever been diagnosed with HIV/AIDS, hepatitis or immune disorders? *This question is required.
15. Have you ever taken or consumed recreational or illegal drugs? *This question is required.
16. Have you ever been diagnosed with any form of cancer, including skin cancer? *This question is required.
17. Have you ever suffered from or received treatment for arthritis, sprains, strains or any bone, ligament or joint problems? *This question is required.
18. Have you undergone any surgical operations? *This question is required.
19. Do you have any allergies including food or drug allergies? *This question is required.
20. Have you ever been admitted to hospital for injury or illness? *This question is required.
21. Have you ever had any diagnostic investigations e.g. CT scan, X-ray or MRI? *This question is required.
22. Do you or should you wear glasses or contact lenses? *This question is required.
23. Are you colour blind to any degree? *This question is required.
24. Do you have any problems hearing? *This question is required.
25. Do you have any other physical or psychological impairment not listed above, which may interfere with your ability to perform the tasks as set out in the Job Description for the position you seek with the company. *This question is required.
26. Have you been vaccinated for any of the following: *This question is required.
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