Return to Work Risk Assessment

  • Identify the hazards that are high priority and complete the fields accordingly. You can assign actions to responsible individuals via this form. You should review your risk assessment if you think it might no longer be valid.

About the Employee

  • Job Title

  • Department

  • Location of Work

  • Next Assessment Due

Risk Assessment

    Hazard
  • Describe the hazard

  • Who might be harmed and how?

  • What are you already doing?

  • What can you still do to control its risk?

  • Action Item Owner

  • Action by When?

  • Completed?

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