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.
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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
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
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
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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