Fit for Work Declaration Form
Editable Word fit for work declaration form for Queensland: a yes or no declaration before a shift or task, a supervisor decision and a short supervisor guide, with no medical history, testing claims or limits.
RG
Written by Ryan Graham, health and safety professional (16 years on Queensland sites)
$9.99 incl. GST
AUD · one-off purchase · instant download
- Instant download · your links arrive by email straight after checkout and work for 3 months, so save your copy
- Make it yours in minutes · edit in Microsoft Word and add your logo
- Quality guarantee · we'll fix any problem, then refund you or give store credit if you're still not happy
- Secure checkout · card, Apple Pay or Google Pay through Stripe
About this template
A short declaration a worker completes before a shift or task: rest, alcohol and drugs, medication, illness or injury, concentration and conditions. It asks yes or no questions only, records the supervisor’s decision (go ahead, adjust the task, stand down or refer) and sets no alcohol, drug or fatigue limit. A one-page supervisor guide covers how to respond privately and respectfully.
What Is Included In Our Fit for Work Declaration Form?
- Worker, site, task and shift details
- Six yes or no questions: rest, alcohol and drugs, medication, illness or injury, concentration and conditions
- No medical history, diagnosis or medication names
- Worker signature and date
- Supervisor decision: go ahead, adjust the task, stand down or refer
- Task adjusted and who was told
- Supervisor guide for a private, respectful response
- The worker and business duties in the WHS Act that the form supports
- Privacy and records reminders
- Links to the related policies and toolbox talks
Legislation and Codes of Practice Referenced
- Work Health and Safety Act 2011 (Qld): ss 19, 28 and 49
- Work Health and Safety Regulation 2011 (Qld): ss 34 to 38 and 40
- Managing the Work Environment and Facilities Code of Practice 2021 (Qld): s 2.3 (paraphrased)
- Privacy Act 1988 (Cth) (general reference only)
What You Get
- An editable Microsoft Word form (2 pages), A4 portrait, to fill in on screen or print
- Tick boxes and date pickers that work in Word
- Business details typed once and filled in on every page, plus a space for your logo
- Sign-off and document control
Review it and adjust it to suit your business, your sites and the way your team works, and talk it through with your workers. If you have any trouble downloading this template, you can contact us at any time. Please make sure you read our Disclaimer before downloading.
Having trouble with your download? Contact us any time. Please read our Disclaimer before downloading.
How to use it
From download to site in three steps
Buy and download
Check out with card, Apple Pay or Google Pay. Your download buttons appear straight away and the links are emailed to you. Links work for 3 months, so save your copies.
Make it yours
Open it in Microsoft Word or Excel. Add your logo, business details, site and job information, and adjust it to how the work is done.
Brief your crew
Talk it through with the workers doing the job, have them sign on, and keep it on site. Review it whenever the job or conditions change.
What format is it?
Microsoft Word. Edit it in Word, or free in Word for the web, and add your own logo and business details.
How do I get it after I pay?
Your download buttons appear as soon as checkout finishes, and the links are emailed to you. You can re-download from your account at any time.
Is it compliant with Queensland law?
It's written around Queensland's Work Health and Safety Act 2011 and Regulation 2011. Tailor it to your site, consult your workers and review it whenever conditions change; no template can guarantee compliance on its own.
What if it isn't right for my job?
If it doesn't match its description or has a fault, tell us and we'll fix it. If you're still not happy, we'll refund you or give you store credit, your choice. Check the sample pages first, as we don't refund a change of mind.
Reviews