Team Member Medical

Qld Team Member Medical Details (CONFIDENTIAL)
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Name
Address
Private Health Insurance

Emergency Contact Details

Primary Contact Name
Secondary Contact Name

Medical Conditions

Diabetes
Asthma
Respiratory
Allergies
Travel Sickness
Blood Pressure
Epilepsy
Medication Allergies
Operations
Other Medications
Other Conditions

Significant Medication Details

If you are taking significant medication which medical professionals may need to know in case of an emergency, please provide the following information:

Any other relevant medical information

Please specific any other relevant information that QWA Team Officials or Emergency Medical Personnel should be aware of
Declaration