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Health Support
Workers Checklist
PLEASE READ
Once completed, please email or post the form back to us.
NOTE: Form not compatible with iMac and MacBook.
TICK AS APPROPRIATE
General HCA Mental Health Support Worker
NO LIMITED HIGHLY
EXPERIENCED
EXPERIENCE EXPERIENCE SKILLED
Hoists:
Please list any hoists you are familiar with:
All types
Pressure relieving equipment
Please list any pressure equipment you are familiar with:
BM machine
Tympanic thermometer
Any other please list below:
PERSONAL DETAILS
I confirm that I have completed this checklist honestly and to the best of my knowledge and abilities.
Print Name: Mohammad Tayyab Khan
Sign: M T Khan
Date: 12/11/16