CQC Supervision Form

HEALTH DECLARATION | Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Schedule 3 Para 8.

Has your physical or mental health changed since your initial Health Declaration was completed when you joined?

Yes

If Yes, please record changes.

Do Direct Healthcare 24 Limited need to make any reasonable adjustments?

Yes

Is a risk assessment required?

Yes

If Yes, REGISTERED MANAGER or CLINICAL LEAD to complete risk assessment and forward to HR .

Signature Section:

Next Supervision Date:

Supervision Completed By:

Candidate Signature:

Date:

I confirm, understand and agree with the above statements.

CQC