Deanery Trainee Occupational Health Employment Mediscreen Clearance Procedure

Please complete all areas of the Health Questionnaire so that you can be cleared for workwithout delay. Every year, a number of Trainees are unable to start work due to avoidable delays and experience a poor start to their Core or Specialty Training; please work with us and the hosts to ensure you will be able to attend on your first day.

Complete the form in full and provide evidence of all immunisation details (use checklist below).

If you are not cleared following this process you will not be able to work and……you will not be paid.

If you require tests and/or immunisations this must unequivocally be carried out on a Mediscreen site.

Foreign Travel and exposure to Tuberculosis can seriously delay clearance. Please complete all areas of the TB assessment. If you require investigation following travel to a high risk country(if not already done) you will require a T-spot blood test. To avoid clearance delays this must be done immediately following entry and repeated 6 weeks later.If there is a delay you will not be cleared to work.

Immunisation details required in all cases - Checklist

Immunisation/Blood Test / Provided / Not available
Dates of Hepatitis B vaccination and 5 year booster
Hep-B surface antibodies - documentary evidence of a previous test >10iu/L.
Documentary evidence of 2 doses of MMR vaccination or copy of a positive blood test results for rubella and measles.
History of Varicella Zoster or evidence of 2 previous doses of VZ vaccine or documentary evidence of immunity if born or raised in subtropical climates.
Documentary evidence of BCG vaccination/visible scar or Mantoux test > 6mm/Heaf test grade 2 or above, in the last 5 years.

Additional Immunisation details required for Exposure Prone Specialties (EPP)

All surgical specialties, anaesthetics, emergency medicine and GP trainees

Hepatitis B surface antigen blood test. (IVS*)
Hepatitis C antibody blood test. (IVS*)
HIV antibody blood test. (IVS*)

*Definition of IVS - identified validated sample – a blood sample taken in an Occupational Health Department (OH) where photo ID was provided at the time of the test –this result must be signed and stamped IVS by the issuing OH Department.

If you still have any questions or would like further information regarding the screening process, please contact the Occupational Health Department on 0161 720 2727 or

The Occupational Health Department at The Pennine Acute Hospitals NHS Trust has asked us to pass on the following message to our new starters.

AS THIS COULD POTENTIALLY AFFECT THE DATE YOU ARE ABLE TO COMMENCE YOUR NEW POST, PLEASE CHECK IF THE COUNTRIES YOU TRAVEL TO ARE LISTED.

The Lead Employer Team

0161 604 5554

From: The Occupational Health Department

()

To: All New Starters 2016

The protection of all staff and patients commences with pre-employment screening. It includes the adoption of safe practices for patient care and methods of preventing and detecting infection in staff at an early stage.

All new employees with patient contact, or contact with clinical specimens, must have a pre-employment assessment which may include medical screening.

Staff who have recently arrived as new entrants to the UK or who have travelled to areas where Tuberculosis incidence rates are greater than 40 cases per 100,000 per year for 4 weeks or more within the last 5 years, must undergo TB screening.

List of affected countries:

More information:

Please ensure that you contact the Occupational Health Department this affects you.

PLEASE NOTE - Screening is usually required six weeks following your return to the UK. However, to enable to give you clearance this can be done on your return and repeated at six weeks, if applicable.

IF YOU HAVE TRAVELLED, OR WILL HAVE TRAVELLED, TO A HIGH RISK TB COUNTRY YOU MUST CONTACT THE OCCUPATIONAL HEALTH DEPARTMENT URGENTLY TO ENSURE THERE IS TO BE NO IMPACT ON THE AGREED START DATE OF EMPLOYMENT.

Thank you.

The Occupational Health Department

Work Health Assessment Form – Guidance Notes

The purpose of the questionnaire is to determine whether you have a health problem affecting your ability to undertake the duties of the post you have been offered or could put you at risk in the workplace. It may be that adjustments or support are recommended as a result of this assessment in order to enable you to do your job. Our aim is to promote and maintain the health of all people at work.

Your answers will be confidential to Occupational Health and will not be given to anyone else without your written permission. We do use anonymised information for audit purposes but will not reveal confidential information in any audit report.

Please complete all relevant sections to avoid delays; we will have to return incomplete forms.

Personal Details: All sections must be completed. Please provide contact details you are happy for us to use and we can use to reach you until you have been cleared.

Consent: If you already have Occupational Health records held in The Pennine Acute Hospitals NHS Trust’s Occupational Health Department for a position with a different Trust or Organisation, then we need your consent to access your existing notes (complete Page 1 only).

Part A – Health Assessment Questions to allow for adjustments or support in the workplace

If you have an illness/impairment or disability that may affect your work and you need adjustments or support then you should complete this section. In particular, health problems that may affect work tasks or be affected by work patterns, such as night work or working environments, should be disclosed.

Part B – Immunisations and Blood Tests – Immunisation Assessment Section

If you will be involved in direct patient care or body fluid sample handling, please ensure you provide details of any previous immunisation and blood tests.

If you require immunisations or blood tests, an appointment will be sent to you by email asking you to attend the Occupational Health Department.

PLEASE INFORM THE OCCUPATIONAL HEALTH DEPARTMENT ABOUT FUTURE TRAVEL PLANS, I.E. IF YOU ARE DUE TO TRAVEL ABROAD IN THE PERIOD BETWEEN SUBMITTING YOUR FORM AND YOUR START DATE.

Private and confidential – Please read the guidance above and complete in full

Position Details:

Post Title: Core/Specialty TraineeSPECIALTY: ______

Organisation: PAHT Lead Employer, Health Education England North West Office

HR Contact:Kelsey Hudson 4

Personal Details (please complete in block letters):

Surname:Dr/Mr/Mrs/Ms/Miss______(as registered with GMC/GDC)

Forenames:______

Former Name(s):______Male/Female (delete as appropriate)

Address:______

______

Post Code:______NHS number: ______DOB: ______

Mobile phone: ______Home number: ______

General Practitioner: ______

GP Address:______

Your email address:______

Are you new to working in the NHSYes/No(delete as appropriate)

Have you ever worked or trained in this TrustYes/No(delete as appropriate)

(If you answer “Yes” to the question above, please consider giving consent to use existing notes)

Please provide details of your most recent current and previous positions:

Job title / Organisation / Specialty/Type of work / Date started / Date left

Consent for PAHT-held Occupational Records to be copied

Previous or present post title:______

Previous or current Organisation: ______

I give consent for my Occupational Health records to be copied, including vaccinations and blood results, and for these records to be used in the assessment for my new position.

Signature: ______Date: ______

Part A – Health Assessment Section

Assessment Criteria / Yes / No
  1. Do you have any illness(es)/impairment(s)/disability (physical or psychological)
which may affect your work (If yes, please give details with dates)?
  1. Have you ever had any illness(es)/impairment(s)/disability which may have been
caused or made worse by your work (If yes, please give details with dates)?
  1. Are you having or waiting for treatment (including medication) or investigation
at present (If yes, please provide further details of condition, treatments and dates)?
  1. Do you think you may need any adjustments or assistance to help you do the job (If
yes, please give details)?

Part B – Immunisation Assessment Section

Immunisations and Blood Tests – Please give details and attach documentary evidence where
Indicated (*). If information is incomplete, you will be required to attend an appointment at the OH dept.
Abbrev / Immunisations and Blood Tests / Yes / No / Dates / Results
Hepatitis / Hepatitis B vaccination / * / Not required
Hepatitis B 5 year booster / * / Not required
Hepatitis B showing titre levels >10iu/ml or indicate if non-responder to vaccine / *
Measles / Measles vaccination / *
Mumps / Mumps vaccination / *
Rubella / Rubella vaccination (German Measles) / *
MMR / MMR vaccination / *
Measles / Measles antibodies / *
Mumps / Mumps antibodies / *
Rubella / Rubella antibodies (German Measles) / *
Chicken
Pox/
Shingles / Have you ever suffered from Chicken Pox/Shingles?
Born or raised in tropical or subtropical climates?
Varicella antibodies tested?
Varicella vaccination received?
HIV Hep B
Hep C / Tested positive for infection of HIV, Hepatitis B or Hepatitis C?
TB / Have you had Tuberculosis (TB) or, in the last 12 months, had any unex-
plained weight loss, night sweats, cough lasting more than 3 weeks or coughing
up blood?
Has a family member or close friend ever been diagnosed as having TB?
To your knowledge, have you had any recent contact with TB?
Have you lived, travelled or worked abroad for more than 4 weeks in the last 5
years? If yes, please answer the following questions in full:
Which country did you reside in or travel to?
What were the dates of your residence or travel?
What was the purpose of your travel?
Where did you stay, i.e. hotel, with family or friends, other?
To the best of your knowledge, did you have any prolonged TB contact, i.e. a
cumulative exposure period > 8 hours within the same room as an
infected case and/or providing care on a dependent infected case
resulting incontact with respiratory secretions?
Since your return to the UK, have you developed any TB symptoms (as above;
If so, please indicate) or been screened for TB?
Mantoux or heaf test, chest x-ray Interferon Gamma Test / * / *
BCG (Tuberculosis Vaccine) / *
If yes, do you have evidence of a BCG scar?
Do you have documented evidence of this?

Part B – Immunisation Assessment Section - continued

Exposure Prone Procedures (EPP) are those procedures where the worker’s gloved hand may be in contact with sharp instruments, needle tips or sharp tissues (e.g. spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.

EPP staff groups include all surgeons, Anaesthetists, Dental staff, Theatre staff and A&E nurses.

EPP staff groups MUST provide documentary evidence of Hepatitis B status. Documentary evidence of Hepatitis C and HIV status is also required for staff undertaking EPPs for the first time. This must be an identified validated sample(IVS, taken with ID check in an occupational health department and lab/immunisation report stamped by that department). Health clearance for EPP work cannot be given until these results have been received and processed by Occupational Health.

If you have previous blood results and/or documented evidence of relevant vaccinations please supply a copy with this questionnaire.

If previous results are not available, you will be tested in the Occupational Health Department and health clearance for EPP work will be delayed until these results have been processed. In compliance with Department of Health Guidelines, you will be asked to show government photographic ID, i.e. valid driver’s license or passport, for this procedure.

Note: Health Care Workers who perform EPPs have a legal duty to inform Occupational Health if they suspect or know they are carriers of HIV, Hepatitis B or Hepatitis C.

Immunisations and Blood Tests / Yes / No / Dates / Results
Hepatitis B surface antibodies (from 1993) and antigen (from 2007)
Hepatitis C antibodies (from 2002)
HIV antibodies (from 2007)

Will you be performing EPP Procedures?Yes/No (delete as appropriate)

If yes, what date did you/will you commence

working in an EPP role within the NHS? ______

Will you be working on a Renal Unit?Yes/No (delete as appropriate)

If yes, you must provide documentary evidenceof Hepatitis B status

Declaration

I declare that all the answers to the above questions and the information provided are true to the best of my knowledge. I agree to comply with immunisation and screening requirements of the post and understand that any failure to comply will result in my manager being informed and may result in restrictions to clinical practice.

Date: ______Signed: ______

I understand that if any recommendations to my manager are necessary as a result of this assessment, OH will discuss the recommendations with me before informing my manager.

Please delete one of the following statements before signing below:

After discussion with Occupational Health, I give consent for a report regarding the recommendations to be sent to my manager, without me having seen a written copy of the recommendations.

OR

I would like to see a written copy (using the email address I have provided above) of any recommendations made by Occupational Health before it is being sent to my manager.

Date: ______Signed: ______

Contact Details for OH: The Pennine Acute Hospitals NHS Trust, Mediscreen – Occupational Health Department, North Manchester General Hospital, Delaunays Road, Manchester, M8 5RB

Phone: 0161 720 27 27 Fax: 0161 720 26 36

Now please return this form and any documentary evidence you have to the OH Dept.