Health Declaration Form
EMPLOYEE HEALTH DECLARATION
- I have read and understood this form and the job description outlined on handbook and I have discussed the employment with the Farm Manager/Employer. I understand the responsibility and physical demands of the employment.
- I acknowledge the I am required to disclosed all pre-existing condition which I believe may be affected by me undertaking the employment.
- I acknowledge the failure to disclose this information or providing false and misleading information may result in not be entitled to compensation or damages under the worker Compensation and Rehabilitation Act 2003 (the Act), for any event that aggravates the non-disclosed pre-existing injury or condition, in the course of employment.
Please list details of all pre-existing conditions
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