RF-F09a-Medical Deficiency Assessment

Name

First Last

Date of assessment

Medical deficiency:

Other medical deficiency:

Scope of work undertaken:

Assessment of risk

Are there any tasks that we carry out that will have an effect of the individual’s ability to undertake our scope of activities?

Control measures

Would the deficiency cause additional hazards to the worksite?

Control measures

Would the deficiency cause additional hazards to the pedestrians?

Control measures

Would the deficiency cause additional hazards to work colleagues?

Control measures

Would the deficiency cause additional hazards when operating Plant?

Control measures

Would the deficiency cause additional hazards when operating small tools?

Control measures

Would the deficiency cause additional hazards when driving?

Control measures

Is the individual safe to undertake scope of the business activities?

Control measures

Is the individual aware that they need to raise concerns where they feel the deficiency held may effect safe working.

Control measures

Additional information

Name of person undertaking assessment:

First Last

Comments

This field is for validation purposes and should be left unchanged.