Information
-
Document No.
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
-
What is the current condition the employee is suffering from? (e.g. Broken leg, broken ankle, etc)
-
List the current symptoms of condition (e.g. pain in injury, unable to bear weight, using crutches, etc)
-
List current medication and any side effects the employee is currently experiencing (e.g. painkillers (specify which), and any side effects this may cause)
-
Does the employee stand for long periods?
-
If yes to above advise employee to make sure they sit down as often as they feel it necessary and to take their designated breaks.
-
Is employee able to use ladders? (If employee is unable to bear weight on each limb or unable to have 3 points of contact on the ladder, then they are unable)
-
Should manual handling be limited?
-
If yes to above advise the employee they are only to lift loads that they fell comfortable lifting and to ask for help when needed.
-
Can employee use work equipment? (Pallet trucks/cages/vacuum cleaner)
-
Arrange a review date for next Risk Assessment
-
Has Risk Manager / Employee relations been briefed on necessary information relating to employees condition?
-
Please sign in the space provided
