Questionnaire for quotation

Questionnaire for applicants for provided services

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(processing the proposal to ensure occupational health service)

Thank you in advance for cooperation and sending the documents

Company identification data:

Objects of the company

Organization structure

Professional composition and number of employees

(Administrative work activities should be reported under the common title Cross Functions)
(Profession specifics: night shift (NS), work at height (H) risk factors: noise (N), dust (D), vibration (V), chemical factors (ChF), biological factors (BF), carcinogenic substances (CS), lightning (L), electromagnetic radiation (EMR), neuro-psychological strain (NPS), work with PC (PC)

Workplace

Profession

No. of employees

Risk factors

Workplace1

Profession1

No. of employees1

Risk factors1

Workplace2

Profession2

No. of employees2

Risk factors2

Workplace3

Profession3

No. of employees3

Risk factors3

Workplace4

Profession4

No. of employees4

Risk factors4

Detached workplace

Professional composition and number of employees at detached workplaces

(Administrative work activities should be reported under the common title CF)

Workplace

Profession

No. of employees

Risks factors

Workplace1

Profession1

No. of employees1

Risks factors1

Workplace2

Profession2

No. of employees2

Risks factors2

Workplace3

Profession3

No. of employees3

Risks factors3

Workplace4

Profession4

No. of employees4

Risks factors4

Requirements for occupational health services by the employer

The current system providing preventive medical examinations

* Required field

I agree with the processing of personal data pursuant to § 13 par. 1, letter a) of Act no. 18/2018 Z. z. on the protection of personal data by MEDISON, s.r.o, for the purpose of communication. (more info here)
By granting consent, I declare that I am 16 years of age.

Contact from all over Slovakia, head office KOŠICE

Office:
MEDISON, s.r.o.
Letná 27
040 01 Košice

cell phone: +421 905 630 917
medison@medison-pzs.sk

Contact for Spišská Nová Ves, Levoča and surroundings:

Office:
MEDISON, s.r.o.
Štefánikovo námestie 4
052 01 Spišská Nová Ves

cell phone: +421 911 011 205
medison@medison-pzs.sk

Contact for Bratislava, Trnava, Nitra and Trenčín regions:

MEDISON, s.r.o.

cell phone: +421 910 900 728
medison@medison-pzs.sk