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Fitness To Work Assessment Form Template

Staff should be ‘fit to work’ at all times. This means that they must not be suffering from, or carrying, an illness or disease that could cause a problem with food safety. People who are not ‘fit to work’ could spread food poisoning bacteria to food. No food handler with gastroenteritis should work while they have symptoms. Any member of staff who has diarrhoea and/or vomiting must by law report it to their manager immediately. They may be asked to stay at home or go home straight away and consult their doctor. The law puts the responsibility on employers to satisfy themselves that no food handlers pose a risk to food safety.
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Fitness To Work Assessment Form Template

General Information

Name of Employee

Date of Assessment

Reason for Assessment

Assessment

Have you suffered from diarrhoea and/or vomiting within the last 48 hours?

At present are you suffering from:

infected wounds, skin infections or sores?

boils, styes or septic fingers?

discharge from eye, ear or gums/mouth?

Have you ever had, or are you known to be a carrier of typhoid or paratyphoid?

In the last 21 days have you been in contact with anyone, at home or abroad, who may have been suffering from typhoid or paratyphoid?

If the answer to any question is ‘yes’, the individual should not be permitted to handle food or enter food handling areas if there is any likelihood of direct or indirect contamination. Further advice should be sought e.g. from your Environmental Health Officer and/or Doctor.

Action Taken

Confirmation

Owner's/Manager's Signature

Date

I hereby declare that the information I have given is correct and I undertake to notify my employer/manager if I suffer from any of the above illnesses/conditions.

Employee's Signature

Date

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