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Covid-19 Risk Assessment Tool For Employees: Template


Facilitate your workplace risk assessments by making sure you keep track of employee health limitations and needs. Use this tool, designed for safety managers to develop safety strategies and keep everyone safe.


The higher the score after filling out the form, the higher the risk for the employee in question and the more you can think about which measures to apply.


You can also use a Covid sign in sheet to record employees' exposure to the virus and help decrease its spread.


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Covid-19 Risk Assessment Tool For Employees: Template

Certain personal information directly relates to being at a higher or lower risk for a COVID infection (e.g. age, chronic or previous illness). We need to collect this data in order to ensure maximum safety for all our staff.
Name
Department
Age
Sex at Birth
(check name not set)

Previous Illness

Diabetes?
Obesity? (BMI ≥ 35kg/m2)
Pulmonary Disease?
Cardiovascular Disease?
Signature
Date
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