Information
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Name of Report
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Site conducted
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If TESCO, please enter site and either base Entertainer store or TSM
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Employee Name
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Conducted on
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Review Date
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What is the current condition the employee is suffering from?
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List the current symptoms of condition
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List current medication person is on.
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List any side effects we need to be aware of
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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?
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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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Is the employee able to lone work
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Notes
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Arrange a review date for next Risk Assessment
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Has manager been briefed on necessary information relating to employees condition?
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Please sign in the space provided
