General Health Questionnaire Template (Page 2 of 2) in pdf

GENERAL HEALTH QUESTIONS

JOB-RELATED CONSIDERATIONS?

HEALTH TIP

The following is a list of general questions that any patient

The following have been identified as health considerations

As a law enforcement professional, you are at

an increased risk of the following serious medical

should ask his or her physician during a physical:

for law enforcement officers due to the nature of the

conditions:

profession. Address the following with your doctor:

- Heart disease

- Cirrhosis

Weight:

- Cancer

- Suicide

My job necessitates that I wear heavy

equipment on my belt and a bullet-resistant

- Respiratory issues

- Joint and back issues

What is a healthy, realistic weight for me? ______________

vest for safety purposes:

- Diabetes

What should a healthy diet include? ___________________

How can I reduce the potential long-term effects of this added

weight on my upper body?

__________________________________________________

Notes:

What are some strategies for strengthening my upper/lower

body muscles to better support the equipment weight?

__________________________________________________

Do you have recommendations on how I can improve my

What should be my recommended daily fat, caloric, and

posture both on and off the job?

cholesterol intake? __________________________________

__________________________________________________

My sleep schedule is often irregular because

__________________________________________________

of my shift hours:

__________________________________________________

What steps can I take to balance a healthy sleep schedule

with the demands of my shift work?

__________________________________________________

Based on Age

How can I make sure that I am getting quality sleep without

__________________________________________________

the aid of medication?

What medical tests should I be having at my age? ________

I find myself snoring; what might be the cause of this, and

__________________________________________________

how can it be treated?

__________________________________________________

What are the potential long-term risks of regularly working

__________________________________________________

overnight shifts and sleeping during daylight hours?

__________________________________________________

Based on my age and overall health, what types of

I am often idle in my vehicle for extended

physical activity are appropriate for me? ________________

__________________________________________________

periods of time:

__________________________________________________

How might extended periods of inactivity impact my health?

__________________________________________________

How much daily physical activity is recommended for some-

Sometimes I find that I eat and drink very little over the course

one my age? _______________________________________

of a shift, and when I do eat, often it’s a rushed, unhealthy

__________________________________________________

meal…typically fast food. What are some ways that I could

Are there certain activities I should avoid? _______________

improve on these habits?

__________________________________________________

Am I at a good fitness level for the demands of my profession?

__________________________________________________

Do you know of an expert who is knowledgeable about

fitness techniques useful to law enforcement?

__________________________________________________

HEALTH TIP

I often have little energy to work out while off-duty. How can I

best retain this energy to ensure I’m getting my exercise?

If you are over the age of 37, you should consider

Remember:

“

early diagnosis and

Family medical history considerations:

asking your doctors for the following tests:

help prevent

appropriate rehabilitation will

1. An exercise treadmill test to examine heart

How does my family’s medical history affect my health?

health

min-

acute injuries from becoming chronic, and

Does anything about my family’s medical history point to

2. Coronary calcium scan to test for Coronary

potential mental health issues?

Artery Disease (CAD)

imize risk

of costly re-injury”

3. Advanced lipid panel test to examine

What effects can on-the-job stress have on my overall health?

– Rod Hilvers, MD.

cholesterol levels

And what are some recommended stress management

exercises?

General Health Questionnaire Template Page 2

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