Have you had any medical problems in the past that have prevented you from working at night?*
Are you subject to angina, or any other heart problems that may affect your fitness to work?*
Have you had duodenal or stomach ulcers in the past, or are you under treatment for those at present?*
Have you had any continuing bowel problems, for instance, following a major surgery?*
Do you have any chronic chest problems such as asthma, emphysema, or bronchiectasis?*
Do you have any disability affecting mobility that will cause you difficulties in arranging night work?*
Do you have any recurrent or continuing sleep disturbance requiring medical advice?*
Are you having specialist care requiring your attendance at hospital clinics for your treatment?*
Do you have any other health problem that affects your fitness for night work?*
Are you taking any medication to a strict timetable?*
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