Personal Risk Factor Checklist

Author: Novade Solutions

Published on: 10/4/2021

General information

Name of risk assessor:

Date of assessment:

Job being assessed:

Location of assessment:

Name of employee being assessed:

*Has the employee had a pre-exposure medical examination by a qualified occupational health professional?

IF YES - Have they been cleared to work in an environment where they may be at risk from heat stress

IF NO - Consult a physician

When was their last medical screening done?

When is their next medical screening due?

*Before this assessment had the employee completed a pre-exposure medical questionnaire?

IF YES - Were any YES answers provided in the pre-exposure medical questionnaire?

(If YES consult a physician?)

When was the questionnaire last administered?

Please provide any other information that may be relevant to this part of the assessment.