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Unit 3, John Joe Sheehy Rd
Tralee, Co. Kerry
V92KN77
[email protected]
066-4010195
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Pre Course Questionnaire
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Pre Course Questionnaire
Your Details
Name
*
First
Last
Email
*
Health Declarations
Joint Injuries
*
Have you any past/current joint injuries that may need to be considered before you participate in the course? (e.g. wrist, elbow, shoulder, knee, ankle, etc.)
Yes
No
Details of your Joint Injuries
*
Muscle Injuries
*
Have you any past /current muscle injuries that may need to be considered before you participate in the course?
Yes
No
Details of your muscle injuries
*
Back Injuries
*
Have you any past /current back injuries that may need to be considered before you participate in the course?
Yes
No
Details of your back injuries
*
Neck Injuries
*
Have you any past/current neck injuries that may need to be considered before you participate in the course?
Yes
No
Details of your neck injuries
*
General Health
*
Is there anything about your health, which may prevent you from engaging in physical demonstrations or do you have concerns, which you need to share with your employer?
Yes
No
Details of your general health that you wish to share
*
Numeracy / Literacy
*
Have you any issues with literacy/numeracy that may need to be considered before you participate in the course? If Yes please speak to Instructor prior to training to decide how best to support you.
Yes
No
Details of your literacy / numeracy that you wish to share
*
Declaration
The information that I have provided in this form is true to the best of my knowledge.
Your Signature
*
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Date Signed
*
DD slash MM slash YYYY