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Gloster Aviation Medicals Risk Assessment Questionnaire
The CAA requires us to individually risk assess each client before we can undertake their medical examination. Please complete the following questionnaire.
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* Indicates required question
Full name and CAA reference number:
*
Your answer
Have you had a POSITIVE Covid-19 test result?
*
Yes
No
If 'yes' then when?
Your answer
Are you prepared to bring your own face covering and wear it for the duration of your medical?
*
See:
https://www.gov.uk/government/publications/staying-safe-outside-your-home/staying-safe-outside-your-home
Yes
No
Please DO NOT attend for your medical examination if you or a household member has had symptoms of Covid-19 in the 14 days prior to your appointment.
*
I confirm I have read and understood the above statement
FOR OFFICE USE ONLY - PLEASE CLICK SUBMIT AT THE BOTTOM OF THIS PAGE TO COMPLETE
Next section is for completion by the AME on the day of the medical.
Date & time of risk assessment:
Your answer
Has the pilot or any respective household member had any Covid-19 symptoms in the last 14 days, or are required to quarantine due to recent travel?
Yes
No
Clear selection
What is the pilot's temperature on the day of the medical?
Your answer
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