Return to Work Risk Assessment

Author: Novade Solutions

Use this Return to work Risk Assessment template to document the risk assessment review for a person returning to work. Record risks identified by the assessment, preventive or protective measures to ensure the employee's safety, prohibited duties and tasks etc.. ** This template has been adapted from CITB

Published on: 6/21/2021

Return to work risk assessment

General Information

Company name

Project title

Location

Contract no.

Name of person returning to work

Employee no

Date of birth

Occupation

Period of absence from work

Nature of injury, illness or condition that rendered the person unfit for work

Department/site

*Has a fit note been obtained from the doctor?

*Is occupational health advice required?

Is occupational health advice required? If ‘Yes’ state advice given

Proposed working hours

Safety induction carried out by

Nature of work to be undertaken

Specific work that must not be undertaken

Specific hazards/risks identified

Control measures required

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