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
Who might be harmed and how?
What are you already doing?
What can you still do to control its risk?
Return to Work Risk Assessment Form Template
This return to work risk assessment form is intended to be used to list the identified safety implications associated with the return to work process of employees that are high-risk. The risk assessment process should consider the impact of the workplace on the returning employee’s ability to work and if there are existing controls to help mitigate the risk to the employee.
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended
take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or
or other applicable laws. You should also seek your own professional advice to determine if the use of such
permissible in your workplace or jurisdiction.