Return to Work Risk Assessment Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please note - This form is confidential and the results can only be accessed by the head teacher, however Some information gathered may be shared with your line manager or office staff according to the adaptations we will make to manage minimising the risk to you returning to work safelyConfirmation *I agreeI disagreeName *Email *What was the main reason for your time away from work? *Physical (e.g. recovering from surgery)SicknessMental healthMaternity/Paretnity/Adoption leaveWitness at court/Jury dutySummarise the physical impediment you hade.g. heart surgery, knee replacement, broken arm, etc.Summarise the illness you developed *e.g. coronavirus, bronchitis, cancer, stroke, diabetes, etc.Summarise the mental health concerns you had *e.g. depression or low mood, bereavement, family matters, anxiety, etc.When returning to school, what areas pose the most risk to you? *Physical activitySchool enviromentPupilsColleaguesGoing on tripsOtherTell us the other areas that pose the most risk to you *What should you not do upon returning?Lift heavy itemsTwist or turnJump, roll or runExtended walking (e.g. trips)Crouching at pupils' levelSitting still for too longUse cleaning equipment like vacuums and mopsOtherTell us the other area(s) that you should not do upon returning *What adaptations to the school environment does the school need to change?The washroom facilitiesAccess points (e.g adding a ramp)Additional chair/table for your useAdditional soft furnishingsOtherTell us how else we need to change the school environment *Tell us how we can minimise the risk to you re pupils *Tell us how we can minimise the risk to you re colleages *Tell us how we can minimise the risk to you re going on trips *Have you agreed with your line manager a phased return?YesNoWhat was agreed?Returning with fewer hours to begin withReturning to a different role within the schoolWhich days and hours were agreed? *Summarise the change to your role and why *Does your doctor/OH believe you are fit to return to work? *YesNoIs there anything else you would like to tell us?Submit
