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Stemax Consult Milton Keynes

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Pre-Travel Occupational Health Risk Assessment

Pre-Travel Occupational Health Risk Assessment | CYP Health

Pre-Travel Occupational Health Risk Assessment

Please complete this confidential online assessment before your travel health appointment with CYP Health. It takes around 6 minutes and helps our clinicians prepare the right occupational health advice, fitness-to-travel guidance and vaccinations for your trip.

Confidentiality: Your individual health answers are seen only by CYP Health’s clinical team and are used to prepare for your consultation, in line with our Privacy Policy and UK GDPR. They are not shared with your employer without your separate explicit consent — see the consent section for details.
This form is not for emergencies. If you have an urgent medical concern, call 999 or attend your nearest A&E.
1
Your Details
2
Trip Details
3
Activities
4
Health Screening
5
Consent

Your Details

So we can identify your record and get in touch about your appointment.

Trip Details

Tell us about your itinerary so we can assess destination-specific risks.

Is this trip arranged or funded by your employer?
Will you be travelling to rural or remote areas with limited access to medical care?
Have you travelled to this destination or a similar region before?
Do you have travel insurance for this trip, including cover for medical treatment and repatriation?
Do any of the following apply to you, or anyone travelling with you? (select all that apply)

Planned Activities & Exposure Risks

Select anything that applies to your trip — this affects the vaccines and advice we recommend.

Will your trip involve any of the following?
To your knowledge, is malaria a risk in the area(s) you are visiting?
Does this trip require an occupational health fitness-to-travel clearance?

Health Screening

This helps us identify anything that could affect which vaccines or medication are safe and suitable for you. You’re welcome to simply select “Yes” and discuss details in person rather than typing them here.

Do you have any existing medical conditions?
Are you currently taking any medications?
Do you have any known drug, food or vaccine allergies?
Do you have a weakened immune system? (e.g. due to illness, chemotherapy, immunosuppressant medication, HIV, or no spleen)
Do you have any chronic conditions such as diabetes, heart or respiratory disease, epilepsy, or a bleeding disorder?
Have you ever had a serious reaction to a vaccine?

Vaccination History & Consent

Finally, a few questions about your vaccination history, then please review and confirm below.

Are your routine UK vaccinations up to date? (e.g. MMR, tetanus/diphtheria/polio)
Have you previously had any of the following vaccines? (select all that apply)
Do you have a vaccination record or certificate you can bring to your appointment?