Medical Observation Form

Medical Observation Form

This medical observation form:

  • Can assist you determine if a person is fit for work.
  • Can assess a person’s ability to perform his/her work safely.
  • Can be very easily edited and customized so you can create your own medical observation form.


– Price Includes All Taxes


What is a Medical Observation Form?

A medical observation form is an assessment guide that can be used to assess if a worker is fit for duty. The form can help with an analysis of a person’s condition to determine their ability to work safely.

Fitness for Work

Medical Observation

If a person presents for work in an unfit state, the following actions may need to be taken:

  • The person may need to be immediately removed from their place of work and be prohibited from driving a vehicle.
  • Transport should be arranged for the person to go back to their home, if necessary.
  • Before permitting the person back to work, discussions and investigations about the matter should be undertaken to determine if the person is fit to conduct work activities safely.

Prescription or Over the Counter Drugs

If a person has used, or intends to use, prescription or over the counter drugs, it is the responsibility of that person to ensure that the drug in question will not cause any impairment that may adversely affect the safety and health of themselves and any other workers at the workplace.

All personnel should declare the use of any prescribed or non-prescribed medication that can potentially impair that person’s ability to perform their normal duties (as advised by a prescribing practitioner).

Contents of this Medical Observation Form

This form has provisions and prompts to assess and record the condition and characteristics of a person, inclusive of:

  • Name.
  • Type of work.
  • Record of observed characteristics.
  • Face and skin appearance.
  • Attitude.
  • Actions
  • Eyes.
  • Breathing.
  • Speech.
  • Balance.
  • Movements.
  • Opinion on level of intoxication.
  • Indicators.
  • Final comments.

Why Choose to Buy this Medical Observation Form

This 1-page form can assist you determine if a person is fit for work. You can use the form if you think a worker may be affected by a drug, medication or alcohol, which could impair their ability to perform his/her work safely.

After purchasing this template you will be able to:

  • Very easily edit and customize the template to create your own medical observation form.
  • Apply your own style, format and brand to the medical observation form.
  • Use it in any industry or sector regardless of size or type of organization.

Availability and Use of this Medical Observation Form

  • This template is accessible to you right now by clicking the ‘Buy Now’ button.
  • The form will be delivered to you in fully editable Microsoft Word format for immediate and full use in your business.
  • There are no subscriptions, contracts or ongoing costs.

Medical Observation Form Guarantee

This Form is 100% Satisfaction Guaranteed.


You may also need: