StartHealth · Template version 2026-10-26

Workplace assessment preparation worksheet

Before the workplace assessment, gather a description of tasks, working locations, working hours and known workload factors. Use this worksheet to agree participation, delivery of background material and follow-up. It helps you prepare; the occupational health professional performs the actual assessment.

Blank company-process preparation template, not an individual employee case form. Do not enter names, diagnoses, medication, absence history or identifiable case details. Use the employer’s approved secure process for real employee cases. This template does not store or submit information. Editorial process aid, not individual medical or legal advice; medical review pending.

Complete blank fields describing company procedures. Use the browser print dialog for A4 paper or PDF. The blank HTML also works offline.

Company and responsibilities

Description of work

Material and participation

Confirm with occupational health

Action / agenda preparation

Work-related observationProposed actionOwner ROLETarget dateFollow-up status

Fictitious example

A fictitious 12-person software team describes interruptions in shared messaging channels. Preparation records a proposal for protected concentration periods, the role responsible for prioritisation and a review date. Occupational health evaluates the significance separately. This is not evidence of a medical outcome.

Questions about the template

Does this replace the workplace assessment?

No. This is preparation. An occupational health professional carries out the actual assessment and report.

What should we bring?

Descriptions of work and locations, the existing risk assessment and the status of previous actions. Do not include employee health statistics.

Is a remote visit sufficient?

The provider assesses an appropriate method for the workplace’s needs; this worksheet does not decide whether remote delivery is sufficient.