Sydney Water Health & Wellbeing Self-Assessment

Sydney Water Health and Wellbeing Self-Assessment

Participant Details

First Name:

Family Name:

Date Of Birth:

Gender:

Email Address:

Mobile Phone No:

Alternate Phone No:

*At least one phone number is required

Business Group:

Level 3 Business Unit:

Are you currently working at a Sydney Water site?

Yes

Privacy Information and Consent

Your privacy is important to us. Injurynet's Privacy Statement is available at www.injurynet.com.au/privacy and provides details about how we manage, collect, hold, use and disclose personal information. It also provides information about how you can request to access, update or correct your information or make a complaint if you have any privacy concerns.

If you have any questions regarding your online self-assessment please phone Injurynet on (03) 9500 9968 or email [email protected]

Declaration

The Health and Wellbeing Self-Assessment Questionnaire is confidential and access is limited to a “need to know” basis. The employer will be provided with your demographic details and the assessment outcome recommendation, but will not be provided with the specific answers to your questionnaire or any details of any medical or other personal information that you enter. The full questionnaire may be provided to a general practitioner or psychologist in cases where an appointment is booked following completion of the self-assessment. You will receive a copy of the recommendations suggested.

I hereby declare that:

I have read and understood the conditions of this self-assessment.
I understand that my demographic information and the outcome recommendation of the self-assessment questionnaire will be provided to my employer.
I understand that the information I provide may be provided to Injurynet practitioners where an appointment is booked through the service.
I am aware that a copy of Injurynet’s Privacy Statement is available at www.injurynet.com.au/privacy and that this statement provides details about how I can access, update and correct my information and, if I am concerned about how this information has been handled, how I can lodge a privacy complaint including how this will be dealt with.

By entering your details above and selecting the proceed button you are declaring that you are the person to whom this assessment was directed, that the assessment was completed by you and that you have read and understood the declaration above.