Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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What is the current condition the employee is suffering from? (e.g. Broken leg, broken arm, etc)
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List the current symptoms of condition (e.g. pain in injury, unable to bear weight, using crutches, etc)
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List current medication and any side effects the employee is currently experiencing (e.g. painkillers (specify which), and any side effects this may cause)
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Does the employee stand for long periods?
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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.
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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)
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Should manual handling be limited?
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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.
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Can employee use work equipment? (Pallet trucks/cages/vacuum cleaner)
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Arrange a review date for next Risk Assessment
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Has Risk Manager / Employee relations been briefed on necessary information relating to employees condition?
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Please sign in the space provided
