Templates
Fitness-To-Work Assessment Form Template

Fitness-To-Work Assessment Form Template

This form may be used for existing food handlers, for new food handlers on recruitment, and for the return of food handlers to work after illness.

Use this template
or download pdf
Fitness-To-Work Assessment Form Template

This form may be used for existing food handlers, for new food handlers on recruitment, and for the return of food handlers to work after illness.

Use this template
or download pdf

About the Fitness-To-Work Assessment Form Template

This form template can help employers assess an employee’s fitness to perform their job. It covers physical, mental and emotional factors, and can be customized to fit the needs of any organization. With this form, employers can quickly and easily evaluate an employee’s readiness for work.

This Fitness-To-Work Assessment Form Template is a comprehensive and easy-to-use tool used to evaluate an individual's physical capabilities for a specific job. It covers a wide range of factors including job duties, physical requirements, medical history, and overall health and wellness. The form enables the employer to accurately assess the employee's ability to perform the job and make informed decisions about their hiring. It also helps to ensure that the employee is fit for the job, and provides evidence that the employer has taken all reasonable steps to protect the employee's health and safety.

Related categories

Preview of the template
Fitness To Work
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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This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.