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PERSONAL DETAILS
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Field is required!
Field is required!
Field is required!
Date of birth
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What's your gender?
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Male
Female
Area checked
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Full body
Specific
if above answer is Specific, describe:
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DERMATOLOGIC HISTORY
When did you last have a skin cancer check?
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Never
6 months
1 year
2 or more years
Have you ever had a skin cancer or sun spot removed?
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Yes
No
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Has anyone in your immediate family had skin cancer?
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Yes
No
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Have you had 3 or more sunburnt episodes, blistering your skin, within your lifetime?
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Yes
No
Have you ever used a solarium?
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Yes
No
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Do you have a lesion of concern?
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Yes
No
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Where do you do most of your job?
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Mostly outdoors
Mostly indoors
RELEASE OF INFORMATION AND PARTICIPATION CONSENT
Participant Release of Information Consent pursuant to Federal Privacy Act 1988 (AU) or Privacy Act 1993 (NZ)
I confirm that my participation in this Skin Cancer Check is voluntary.
I acknowledge that any personally identifiable health information obtained in conjunction with this health check will be protected and will only be used in accordance with this agreement and applicable laws pertaining to the use of personal health information.
I understand that any health information obtained, may be used to compile a deidentified aggregate report for my company/employer. My individually identifiable health information will not be shared with my employer.
I consent to the collection of data on my skin type, sun damage and sun damage type.
I understand that the data derived from the check is considered to be preliminary and for screening assessments only. The data collected does not constitute a diagnosis. The responsibility for initiating a follow-up examination to confirm the results of this screening and obtain professional assistance is mine alone and not that of my employer or any organisation associated with these skin cancer checks.
I hereby give Bodycare Health & Wellbeing Pty Ltd consent to release the de-identified results of my health questionnaire as part of an aggregate result to the relevant department of my employer.
Participant Release of Information Consent pursuant to Federal Privacy Act 1988 (AU) or Privacy Act 1993 (NZ)
I confirm that my participation in this Skin Cancer Check is voluntary.
I acknowledge that any personally identifiable health information obtained in conjunction with this health check will be protected and will only be used in accordance with this agreement and applicable laws pertaining to the use of personal health information.
I understand that any health information obtained, may be used to compile a deidentified aggregate report for my company/employer. My individually identifiable health information will not be shared with my employer.
I consent to the collection of data on my skin type, sun damage and sun damage type.
I understand that the data derived from the check is considered to be preliminary and for screening assessments only. The data collected does not constitute a diagnosis. The responsibility for initiating a follow-up examination to confirm the results of this screening and obtain professional assistance is mine alone and not that of my employer or any organisation associated with these skin cancer checks.
I hereby give Bodycare Health & Wellbeing Pty Ltd consent to release the de-identified results of my health questionnaire as part of an aggregate result to the relevant department of my employer.
Field is required!
Field is required!
SKIN CHECK RESULTS
Skin Type
Skin Type (Fitzgerald)
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I
II
III
IV
V
VI
Sun Damage
Sun damage:
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Severe
Moderate
Average
Not Significant
Sun damage type:
Actinic kerastosis
Dysplastic Nevi
Pigmented
Basal Cell Carcinoma
Squamous Cell Carcinoma
Melanoma
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Follow Up
Are you under the care of a doctor or specialist for your skin?
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Yes
No
Is a follow up required?
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Yes
No
Notes
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Submit
Home
COVID-19 Support
Our COVID-19 Approach
Workplace Temperature Checks
Virtual Ergonomic Assessments
Virtual Wellness Workshops
Challenges
Well at Work Newsletter
Resources
Services
Health Checks & Consultations
Health Checks
Heart Checks
Skin Checks
Hearing Checks
Lung Function (Spirometry) Checks
Posture & Musculoskeletal Check
Vision Tests
Core Stability and Flexibility Checks
Health Consultations
Seated Massage
Sleep Consultation
Flu Vaccinations
Challenges
Seminars & Training
Mental Health & Stress Seminars and Workshops
Workplace Mental Health First Aid
Health Awareness Seminars
Corporate Diet & Nutrition Seminars
Health & Safety
Manual Handling Program
Ergonomic Assessments
Digital Solutions
MyHealthworks
Education Resources
Well at Work Newsletter
Educational Health Booklets
Corporate Fitness
About Us
Our Team
Our Approach
Resources
Blog
Contact