Need for Workplace Naloxone Kit Assessment Form
Should you implement a naloxone program in case somebody suffers an opioid overdose at your workplace? Here’s a template assessment form you can use to make that determination. Note: If you’re in Ontario, you must implement a naloxone program at your workplace by June 1, 2023 if the risk of overdose at your site is high.
| Company Name: Date: |
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| RISK: (List all staff, client groups, visitors and members of the public who may be at risk of suffering an opioid overdose at your workplace) |
| RISK ASSESSMENT: (Provide a general description of the risks to staff, client groups and members of the public) |
| RISK CONTROLS: (Provide a general description of the measures, if any, that are currently in place to minimize the identified risks to each group and what, if any, gaps exist) |
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