HOME WORKER TRIAGE – EMPLOYEE – Innovate Healthcare

CONSENT PAGE

Consent and How we use your data :
Innovate Healthcare Management Group Limited (“Innovate”) respects your privacy and is committed to protecting your personal data. This privacy notice will inform you as to how we look after your personal data when you utilise our Triage Service, and tell you about your privacy rights and how the law protects you.

Who we are :
We are, Innovate Healthcare Management Group Limited and our office is based at Dale House, Tiviot Dale, Stockport, SK1 1TA. We are a registered company in England and Wales under company number 07758732. We are registered on the Information Commissioner’s Office Register; registration number Z3289411. We act as a data controller while processing your information, for further information, or to exercise any of your rights under the Data Protection Act 2018, please contact our Data Protection Officer at data.requests@innovatehmg.co.uk or at the postal address above.

During this assessment, we will collect the following information from you :
Personal Information including: name, contact information, employment and work-ability data. Special Category information: Health data

How we will use your data :
Following the online assessment, your data may be reviewed by a qualified Case Manager, and an appropriate support pathway recommended.

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I hereby consent to the Triage Assessment and any subsequent support interventions recommended by Innovate Healthcare.

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I agree to my data being held and processed by Innovate Healthcare. Should I require further support interventions, I consent for Innovate Healthcare to share my details with my employer.

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I consent to the outcome of my triage being shared with my referring party (e.g. Employer)

Customer's Company :

Customer Email Address (Referrer) :

Customer Name :

Employee Email :

Surname :

First Name(s) :

Date of Birth*

Address*

House Number : Flat / Apartment : City : Postcode :

Telephone*

Step 1 of 4

Welcome to your Home Worker Triage

Please answer the below questions :