Information

  • Name of staff member:

  • Date of assessment:

  • Agreed assessment review date:

  • This assessment should be used to assess the working conditions of members of staff who are returning to work after a long absence, are suffering chronic incapacity or are suffering stress related
    symptoms.

  • Individuals job title:

  • Type of contract:

  • Reason for assessment:

  • Name of assessor:

Assessment criteria to be observed:

  • Please answer all questions. Actions/control measures should be listed for each question as required. Text boxes can be opened by clicking on the question.

  • Is the individual fully trained in the duties expected of them?

  • Are the individuals working patterns reasonable and appropriate for this sort of work? (if not, please liaise with Human resources)

  • Is the individuals work achievable in a reasonable working day without the need to work long hours or take work home on a daily basis (unless this is a required part of the job)?

  • Can rest breaks be taken on a regular basis?

  • Is the individuals work free from unreasonable physical fatigue (include consideration of manual handling operations and practical delivery sessions) and/or mental fatigue?

  • Is the working environment appropriate (consideration should be given to space allocation, ventilation, lighting, noise, extreme temperatures)

  • Is the individuals work free from unreasonable stress ( consideration should be given to conflict with others, changes within the organisation etc)

  • Is the individuals performance likely to be observed in a classroom, tutorial, workshop or training environment within the next 3 months, in accordance with College policy or Ofsted requirements?<br><br>

  • If so, are there any control measures that need to be applied to assist the individual in these circumstances?

  • Has advice been provided by Occupational Health to assist in determining whether or not additional control measures are necessary?

  • Does a two-way communication channel exist for the individual and their line manager?

  • Can the individual make their feelings known to those with authority to take action if necessary?

  • Has the individual had 3 or more separate sickness absences or accumulated 9 or more days of sickness absencenin a rolling six month period?

  • Signature of individual being assessed:

  • Signature of assessor:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.