A few rules

Preparing for a Fit to Work Assessment (FTWA)

SCENT FREE ENVIRONMENT (no perfume, cologne, body sprays, etc.).

Do not eat a large meal prior to your assessment. A light snack 1-2 hours prior is recommended.

Do not consume any caffeinated beverages or artificial stimulants prior to your assessment. These include coffee, tea, energy drinks, soft drinks, chocolate, cigarettes or over the counter non-drowsy allergy/cold medication.

Please wear comfortable clothing and running shoes (NO dress shoes or open toed shoes).

Please download the Medical Intake Form (2 pages) below onto your phone or computer prior to attending your Fit to Work Assessment (FTWA). See instructions below. Please do not forward to your potential employer.

Downloads

How to fill out Medical Intake Form on an iPhone: click on the form to download. Once downloaded, at the bottom of the screen click on the "Arrow Icon" and scroll down to see options and choose "Markup". Enter the password; fill in form (2 pages) with the exception of the signature which you will do at the end. Tap on blank fields; it will automatically allow you to type in your information. Where you see empty check boxes; tap your finger over the box to create a check mark. Once all fields are completed you are ready to sign the document. To sign, tap the "Pen Icon" at the top right of the screen and sign in the signature area; when done, tap the "Pen Icon" again. Now you are ready to send. Click on the "Arrow Icon" at the bottom left of the screen to share; then choose email (label email as indicated below).

How to fill out Medical Intake Form on a Computer or Android phone: click on the form to download. Open in Adobe Acrobat Reader; save the document first; then fill in form (2 pages), sign and save again. Forward completed medical form via email as indicated below.

Please email completed form with your name in the subject line (last name, first name) to:

fittoworkassessments@gmail.com

FTWA Waiver-Medical Intake Form-2021 (pdf)

Download