Sancon will not knowingly compromise your health and safety. Our organization has a responsibility
to avoid putting workers under employment in a situation that has potential for harm. The requested
information is necessary to ensure your health and safety. Previous injuries or exposure to certain
elements of a task could put your well being at risk. In addition, there are known physical conditions
and disabilities such as epilepsy, diabetes, impaired eyesight, back trouble, heart trouble, aversion
to heights, etc. that could elevate the potential for harm to yourself or those around you. Please
inform our organization of any limitations that you may possess, your safety depends on it. Information
provided on this form will assist with appropriate placement for work in accordance with your limitations
and in no way prevent you from becoming a contributor to our team.
Private matters may be discussed with the Sancon HR Manager and all information will be stored in confidential personnel file.
Name of Contact