Appointed doctor forms

General

• FODMS32 - Certificate of appointment as appointed doctor (not available online)
• FODMS38 - Application to be appointed as an appointed doctor under regulations
• FODMS38R - Renewal of appointment as an appointed doctor

Ionising radiation

• F2067 - Health record
• FODMS101 - Clinical record

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
• Blood lead return of workers under medical surveillance

Asbestos

• FODMS72A - Certificate of Medical examination (not available online – contact HSE Headquarters)
• FODMS75 - Medical Surveillance Questionnaire and Consent Form
  • FODMS75 - Guidance on completing the form
  • FODMS75 - Reference list
  • FODMS75 - Information leaflet for people working with asbestos
  • FODMS75 - Address label
• FODMS100 - Health surveillance record form
• Respiratory symptom questionnaire - licensed work with asbestos - Form MSLW1 - PDF version