KD-OH-HS-001
Health Surveillance Register and Programme
The site's health surveillance programme and register: each exposure on the site mapped to the surveillance it needs — HAVS tiers, audiometry, skin checks, lung function, blood lead, asbestos medicals — then one line per person with the provider, the last date, the next due date and the fitness outcome, with no medical detail on the sheet.
2 pages · 225 fillable fields · works in Adobe Reader, Preview, Chrome, or on a phone — or complete it online in your browser and download the finished document.
Page 1 of 2 — click to enlarge
Read all 2 pages first — watermarked sample, no email Before you submit: the checklist
Statutory basis, cited on the form
- MHSWR 1999 reg 6
- COSHH 2002 reg 11
- Control of Vibration at Work Regulations 2005 reg 7
- Control of Noise at Work Regulations 2005 reg 9
- Control of Lead at Work Regulations 2002 reg 10
- CAR 2012 reg 22
- Data Protection Act 2018 and UK GDPR
Guidance and standards relied on
These are not law. HSE guidance carries no statutory force in itself, British Standards and NASC technical guidance are industry documents, and the Joint Code of Practice is an insurers' code. They are what the document is built to — and where a court would look for the standard of the reasonable contractor.
- ACOP L132 (3rd edition, 2002)
What it is not
It is not a completed document and it is not health and safety advice. You must adapt it to your site and have a competent person complete and sign it off. See why we don't say "compliant".
Format
AcroForm fillable PDF. Every field has a tooltip. Tab order follows the reading order. Works on desktop and mobile, in Adobe and non-Adobe readers.
This revision was prepared against legislation current at 10 August 2026. Revision A0. Check kubitdocs.com/revisions for the current revision before use.
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