Health Risk Assessment Form

Health Risk Assessment Form Template for New Zealand

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Key Requirements PROMPT example:

"I need a Health Risk Assessment Form for our construction company in Auckland, focusing on heavy machinery operators and working at heights, to be implemented by March 2025 and compliant with New Zealand workplace safety regulations."

Document background

The Health Risk Assessment Form serves as a crucial tool for organizations and healthcare providers operating in New Zealand to evaluate and document individual health risks in accordance with legal requirements. This document is essential when conducting pre-employment health screenings, periodic health assessments, or specific risk evaluations in various workplace settings. The form is designed to comply with the Health and Safety at Work Act 2015, Privacy Act 2020, and other relevant New Zealand legislation, ensuring comprehensive collection of health information while maintaining appropriate privacy protections. It should be used whenever there is a need to assess health risks, monitor occupational health impacts, or evaluate fitness for specific roles or activities. The assessment includes various components such as medical history, current health status, risk factors, and specific occupational health considerations.

Suggested Sections

1. Personal Information: Basic details of the person being assessed including name, date of birth, contact information, and relevant ID numbers

2. Privacy Statement: Declaration of how the information will be collected, used, stored and shared, in compliance with the Privacy Act 2020

3. Medical History: General medical history including current conditions, medications, and previous significant health issues

4. Current Health Status: Assessment of current health conditions, symptoms, and general wellbeing

5. Physical Health Assessment: Evaluation of physical health parameters including vital signs, weight, height, and basic physical capabilities

6. Risk Factors: Identification and assessment of specific health risk factors including lifestyle factors, occupational exposures, and environmental risks

7. Mental Health Screening: Basic assessment of mental health status and stress levels

8. Emergency Contact Information: Details of who to contact in case of emergency

9. Declaration: Statement confirming the information provided is true and consent for information use

Optional Sections

1. Occupational History: Details of current and previous employment, particularly relevant for workplace health assessments

2. Family Medical History: Information about familial health conditions, relevant for comprehensive health risk assessments

3. Lifestyle Assessment: Detailed evaluation of diet, exercise, smoking, alcohol consumption, and other lifestyle factors

4. Specific Risk Assessment: Targeted assessment for specific risks relevant to particular workplaces or situations

5. Pregnancy Status: Special considerations for pregnant individuals, when relevant to the assessment

6. Vaccination History: Record of immunizations and vaccinations, particularly important in healthcare settings

7. Previous Accident/Injury History: Detailed information about past accidents or injuries, particularly relevant for workplace assessments

Suggested Schedules

1. Risk Assessment Matrix: Standardized tool for evaluating and scoring different types of health risks

2. Health Monitoring Requirements: Schedule of required ongoing health monitoring based on identified risks

3. Medical Assessment Criteria: Detailed criteria used for various aspects of the health assessment

4. Privacy Policy: Detailed information about data protection and privacy procedures

5. Emergency Response Procedures: Protocols to follow in case of health emergencies

6. Relevant Health and Safety Guidelines: Specific guidelines applicable to the assessment context

7. Follow-up Assessment Schedule: Timeline and requirements for follow-up assessments

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Construction

Manufacturing

Mining

Agriculture

Transportation

Education

Hospitality

Professional Services

Public Sector

Maritime

Aviation

Chemical Industry

Food Processing

Pharmaceutical

Relevant Teams

Human Resources

Health and Safety

Occupational Health

Risk Management

Operations

Compliance

Legal

Employee Relations

Workplace Wellness

Medical Services

Relevant Roles

Occupational Health Nurse

Health and Safety Manager

Human Resources Director

Risk Assessment Officer

Workplace Health Coordinator

Safety Compliance Officer

Industrial Hygienist

Environmental Health Officer

Occupational Health Physician

Health and Safety Consultant

Employee Relations Manager

Workplace Wellness Coordinator

Operations Manager

Site Manager

Project Manager

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