School Health-Surveillance Feedback and Follow-Up Record

If the school does not operate a health-surveillance scheme, do not complete the remaining sections.

Enter the name of the school.

Use the school’s local reference convention, if one is in place.

Enter the date on which the relevant health-surveillance feedback or worker-raised concern was received.

Enter the date on which this record was reviewed.

Enter the name or role of the person completing this record.

Select all applicable sources.

Describe the relevant work activity or exposure area without recording unnecessary personal medical information.

Summarise the issue, reported work-related health effect or preventive feedback. Do not include detailed medical information unless it is necessary and authorised for this record.

Record any immediate action taken to address the feedback or concern.

Select the current assessment.

Describe the action, including any change to controls, work arrangements, information or supervision.

Use the school’s local criteria to determine priority.

Enter the person or role responsible for progressing the action.

Enter the agreed target date where an action is required.

Select the current status of the preventive action.

Enter the date on which the action was completed, if applicable.

Consider whether the feedback or concern identifies a need to reinforce workers’ training or education.

Describe the subject or learning point to be reinforced, if applicable.

Identify the relevant worker group or role.

Enter the planned or completed date, if applicable.

Select whether the record needs a later review or confirmation.

Enter the planned date for follow-up, if required.

Record the outcome of follow-up, any remaining concerns and any further action needed.

Select closed only when the record has been reviewed and no further entry is required at this stage.

Confirm before submitting the record.

• Tick when complete