Health and Safety case form

  • Release version: Australia
  • Updated March 12, 2026
  • 2 minutes to read
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    Summary of Health and Safety Case Form

    The Health and Safety case form is designed for safety case managers to address health and safety inquiries from employees. Submitting a health and safety question generates a safety case, with certain fields pre-populated from the original request. After assignment, a safety agent completes the remaining fields within the Health and Safety Workspace.

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    Key Features

    • Unique Case Number: Each safety case is assigned a system-generated unique number.
    • Short Description: A brief overview of the inquiry.
    • Requested for: Identifies the individual for whom the information is requested.
    • Case Categories: Includes health and safety procedures, training, equipment, injury-related leave, and general inquiries.
    • Related Incidents: Links to any safety incidents or observations when applicable.
    • Return to Work Case: Indicates if the case involves an employee returning to work post-injury or illness, editable only by authorized users.
    • Compensation Claim Case: Identifies if the case pertains to a compensation claim, with specific sections accessible to designated users.
    • Assignment Groups: Displays the safety group assigned to manage the case.
    • Contact Method: Specifies how to contact the individual related to the case.
    • Return to Work Details: Available when applicable, assessing an employee's readiness to return post-injury.

    Key Outcomes

    Utilizing the Health and Safety case form allows safety managers to efficiently manage and resolve inquiries regarding health and safety protocols, ensuring compliance and enhancing employee well-being. Proper use of this form leads to better tracking of health-related issues, timely return-to-work assessments, and adherence to compensation claim processes, ultimately fostering a safer workplace environment.

    Safety case manager can use the safety case form to resolve health and safety questions that they receive from employees.

    When a health and safety question is submitted, it creates a safety case. Some of the fields on the case form are populated from the request from which it is created.

    After the case is assigned, a safety agent fills out the fields on the case from Health and Safety Workspace.

    Table 1. Health and Safety case form
    Field Description
    Number System-generated unique number for the case.
    Short description Brief description of the request.
    Requested for Person for whom the information is requested.
    Category Type of the case or employee's question.
    • Health and safety procedures: Queries related to the organization’s health and safety procedures.
    • Training: Queries related to health and safety training.
    • Equipment: Queries related to health and safety equipment.
    • Injury / Incident related leave: Queries related to leaves due to injuries or incidents and the related return to work considerations.
    • General inquiry: Any other general health and safety queries.
    Related incidents / observations Safety incident or observation this case is related to.

    This field appears only when the Health and Safety Incident Management (sn_hs_im_incident) application is installed on your ServiceNow instance. For more information, see Install Health and Safety Incident Management.
    Return to work case Option whether this case is related to an employee returning to work after an injury or illness. Only a user with the Return to work case writer [sn_hs_cm.rtw_writer] role can edit this field.

    A Return to work case is usually opened related to an incident where an employee was injured and required time off to recover.

    The following items appear when Yes is selected in this field:
    • Return to work details section on the case form.
    • Leaves and Injury and illness tabs for this case.
    Compensation claim case Option whether this case is related to a to compensation claim.
    The following sections appear when Yes is selected in this field. Only a user with the Claim case writer [sn_hs_cm.claim_case_writer] role can edit fields in these sections.
    • Employee claim details
    • Closure details
    Parent case Parent Health and Safety case ID number this case is related to.
    State State of the case.
    Assignment group Safety assignment group the case is assigned to. If the case isn’t assigned to a user yet, any member of this group can work on the case.
    Assigned to User assigned to this case.
    Contact type Method to contact the person this information is requested for, such as email or phone number.
    Description Detailed description of the case.

    Return to work details

    The Return to work details section on the Health and Safety case form appears only when Yes is selected from Return to work case. The fields enable you to assess the employee's capability to work before they return from an injury or illness.

    Only a user with the Return to work case writer [sn_hs_cm.rtw_writer] role can edit fields in this section.

    Table 2. Return to work details fields
    Field Description
    Leave category Reason the employee was away from work.
    Expected return date Date the employee is expected to return to work.
    Medical clearance received Option to indicate whether a medical clearance is received for the employee before they return to work from an injury or illness returning.
    Accommodations needed Changes required to help the employee return to work.
    Work restrictions Limitations identified during the return to work planning for the employee.