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Appointed doctor forms

Below is a list of forms available for appointed doctor work. Most are available on HSE’s website and links are provided.  Certain forms can only be obtained from the HSE office administering appointed doctor work.

General

• FODMS32 - Certificate of appointment as appointed doctor (not available online)
• FODMS32A - Schedule of appointment as an appointed doctor (not available online)
• FODMS38AB - Application to be appointed as an appointed doctor under regulations (Further information must be provided when requesting extension of an appointment to include additional regulations and/or a new company - see Moratorium on new applications)

Ionising radiation

• F2067 - Health record
• FODMS101 - Clinical record
• IRRMED1 - Application for review of a medical decision
• IRRMED2 - Summary of reasons for a medical decision

Lead

• FODMS98 - Initial medical assessment
• FODMS99 - Surveillance record for person exposed to lead
• FODMS102 - Notification to employer of biological test results and record of medical surveillance
• FODMS103 - Certificate of unfitness/fitness

Asbestos

• FODMS72A - Certificate of Medical examination (not available online)
• FODMS75 - Medical surveillance and consent form
• FODMS100 - Health surveillance record form

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