Covid-19 - Workplace Risk Assessment

This tool is intended to help assess your individual risk profile in being able to carry out your role and to work where there is a risk of the infectious disease COVID-19. This tool will consider the risk due to underlying factors, for instance pre-existing health conditions, as well as other co-factors such as age or ethnicity. We are all different in how we view risk. It is important that this is considered consistently, quickly and that you understand how the outcome has been reached.

After completing this short process most people will be able to safely start work straight away/continue to work; some will then also need an occupational health assessment, but this form helps to make sure that key information is captured to allow this assessment to take place as quickly as possible.

The process will help answer the following questions:

  • Do I need a further Individual Risk Assessment due to COVID-19?
  • Do I need consideration of adjustments to be able to carry out my role due to an underlying condition?
  • Are there any other considerations such as PPE that need to be considered?

The process will result in PDF documents that allow you to understand your individual outcome and how this decision has been reached. If there are any recommendations then the reasons will be explained and relevant information provided.

Two versions of the PDF will be produced and clearly labelled. One PDF outcome form will be sent to Occupational Health, to a confidential clinical inbox. This will contain some personal information and will only be viewed by clinical staff. You will have filled in similar forms when you first joined or more recently if you are a new starter for example.

The second PDF outcome form will be sent to your manager if you are an existing staff member, or your HR recruiting contact if you are a new starter. You will see this contains much less information (no medical details) and mainly tells your manager/HR whether you need any restrictions and what to do next.

The questions you will now answer are those needed to assess you against what is known to place individuals at risk due to the infectious disease COVID-19. For those with underlying health conditions it will also help determine whether any consideration might be needed for adjustments to the role or workplace.

By understanding how this risk assessment has been carried out, if you become aware of a change in your circumstances, you will be better able to know whether to raise this with your manager or to request a further assessment. It does not replace an Occupational Health assessment where this is appropriate but does help ensure all staff can be considered against all known and understood risk factors.


We recommend:

Are you comfortable with these recommendations?

If you select no this will advise your line manager that they will need to discuss this with you.

We have generated two, separate, reports describing this recommendation.


You now need to click 'Send Results' to email your manager the outcome only version of the report and to email your occupational health provider with the full version. When you press send you will get a copy of both PDFs sent to your email address that you provided. You can also download them now if you wish as per above.

Sending, please wait...
Thank you - your reports have been sent.


  • Please click to download this report and email it to your manager.

    Please provide the following information so we can identify you.

    What is your first name?
    What is your last name?
    What is your phone number (preferably your mobile number)?
    What is your email address?
    What is your date of birth?
    Please choose which option best fits with your reason for carrying out this risk assessment:
    Which description best describes the type of role your undertake?
    Where do you, or where will you, work?
    Line Manager or HR Recruiting Officer's Email Address:

    Please read the information below.


    No information you provide will be retained on the system or by Rainbird (system provider). By completing and submitting this form, you consent to the information you provide being processed for the purposes set out on the previous page and in line with data protection duties.

    Then select your trust below and click 'Continue'.



    Your trust has not yet signed up to use this tool.
    Please direct you manager to for information on how your trust can use this tool for free.














    Form for Notifying Medical Employment and Risk Assessment Initial Outcome to Line Manager, Human Resources and Occupational Health

    The staff member has indicated that they have concerns about their role and potential impacts on either a household member or someone they have caring responsibilities for- please discuss their concerns as per management guidance and Q+A documents and direct them to the Staff Hub.














    Form for Notifying Medical Employment and Risk Assessment Initial Outcome to Line Manager, Human Resources and Occupational Health

    Guidance for Individual. Completing this form will allow the staff member to understand whether they need any further consideration of risk assessment by either the manager, HR or Occupational Health. It allows the individual to indicate if they feel they are likely to need adjustments or consideration of adjustments as well as to understand if they need further risk assessment in terms of infectious disease risk (e.g. COVID-19). In addition to the manager's report, you are encouraged to share a copy of the Occupational Health version of the report with your manager and to discuss this in order that they can support you with any adjustments.


    This section details the overall risk assessment outcome indicating your ability to work in relation to the Infection COVID-19 and indicates whether you want to discuss the guidance with your line manager.



    Separate to COVID-19 risk, this section indicates whether the individual may require a managerial risk assessment or a referral for Occupational Health for advice due to any underlying health condition(s) i.e. Medical Employability for their role e.g. a new injury preventing return to work or a long standing condition that has recently worsened

    Medical Conditions

    This part indicates whether you have other underlying health conditions, separate to those considered for COVID-19 risk, that require further consideration to your line manager.



    This section indicates any advice about your ability to work/ carry out your role due to considerations relating to COVID-19 and breaks this down into specific areas to help your line manager support you.

    Individual Acceptance

    This part indicates whether you want to discuss the guidance with your line manager.

    Personal Protective

    This part indicates whether / how you are able to use PPE to your line manager.

    Pregnancy Status

    This part indicates whether there are pregnancy related considerations to your line manager.



    Guidance for Occupational Health This form when completed will allow occupational health to be able to carry out a Risk Assessment for working with Infectious Diseases for both current and new staff. It does not replace an individual assessment for those that need this but makes sure that all relevant factors have been captured for further exploration.

    Guidance for Manager. Once completed this form gives the manager an understanding of where the staff member can be employed, whether they need consideration of adjustments and if an occupational health assessment is needed. For existing members of staff the manager will be able to understand whether further HR guidance is needed to answer any specific concerns. For new members of staff there will be an understanding of how they can be safely employed and whether further occupational health advice is needed before this.

    Once completed the PDF marked for Manager / HR should be forwarded to the line manager for existing staff members and to the HR recruiting officer for new staff members.

    It is a managerial matter with HR support to advise you about your concerns about your role and potential impacts on either a household member or someone you have caring responsibilities for. Occupational health supports staff with health conditions and as this is about someone else it is not something OH can advise on directly. You need to read the government guidance and make a decision if you have received a shielding letter about the other person. You may feel happier working in a non COVID-19 area because of this and should talk to your manager about whether this is possible. Here is the Government guidance:

    You may need to revisit the situation regularly every week as the situation changes e.g. if all wards change COVID-19 status.

    This is clearly very difficult for you and you should now discuss your concerns with your line manager