Pupil Return to School Risk Assessment Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Pupil's Name *FirstLastClass *Date of Return to School *Nature of Illness or InjuryPlease describe the injury or illness: (e.g. fractured left wrist, post-viral fatigue, recent surgery) *Date of injury/illness *Was the pupil hospitalised or treated by a medical professional? *YesNoPlease give details *Has the school been provided with medical advice or documentation? *YesNo(e.g. hospital discharge notes, physiotherapy plan, consultant letter)Are any follow-up appointments required? *YesNoIf yes, please list them (if known)Functional Impact and NeedsIs the pupil currently experiencing any of the following: *Reduced mobility (e.g. using crutches, cast, wheelchair)Pain or discomfortFatigue or low energy levelsLimited ability to write, draw, or hold equipmentMedication requirements during the school daySupport with toileting or personal careEmotional distress, anxiety, or traumaOther (please specify)Other: *Are there any activities the pupil must avoid during the school day? *PE/sportsClimbing frames or apparatusRunning or playground activitiesCarrying a school bag or heavy objectsOther (please specify)Other: *School Adjustments and Support RequiredWhat reasonable adjustments are needed to support this pupil? *Adult supervision during movementAlternative seating or deskRest breaksModified curriculum activitiesFirst aid/medical oversightRisk assessments for trips or fire evacuationEmotional supportAccess arrangements for toilet useReduced timetable (short-term)Other (please describe):Other: *Medical Needs and MedicationWill the pupil require any medication during the school day? *YesNoIf yes, has the relevant medication form been completed and signed by a parent/carer? *YesNoIs there an existing Individual Health Care Plan (IHCP)? *YesNo an the Date If no, does one need to be created? *YesNoAgreement and SignatureHas a meeting taken place between the school and parent/carer to agree on a safe return plan? *YesNoDate Arranged *Completed by *FirstLastEmail *Submit
