GWO Requirements for Training Providers V12

GWO Requirements for Training Providers


YOUR PERSONAL HEALTH IS YOUR RESPONSIBILITY. I hereby confirm that I have read and understood the listed risks and potentially life-threatening medical conditions, and confirm that I am physically and medically fit to participate in GWO training. I hereby confirm that there is no factor that will inhibit or affect my participation in GWO training. I agree to follow all instructions from the appointed instructor for the duration of the GWO training. Should there be any doubt regarding my medical fitness, the training provider will stop the training and seek a physician’s advice. Name as in passport Delegate WINDA ID Course module Signature and date The following conditions could pose a risk when you participate in GWO training. Alert your training provider if you suffer from any of the following: • Asthma or other respiratory disorders • Epilepsy, blackouts or other seizures • Angina or other heart complaints • Vertigo or inner ear problems (difficulty with balance) • Claustrophobia/acrophobia (fear of enclosed spaces/heights) • Blood pressure disorder • Diabetes • Pacemaker or implanted defibrillator • Arthritis, osteoarthritis or other muscular/skeletal disorders affecting mobility • Known allergies (e.g. bee/wasp stings or spider bites) • Recent surgery • Any other medical condition or medication dependency that could affect climbing or the physical impact of climbing

Note: This form is an example of a medical self-assessment form. The training provider must modify this form and the medical conditions listed therein to satisfy the legislation and requirements applicable to the geographic locationof the training centre.


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