Information

  • Site / Area Name:

  • Address:
  • Date:

  • Conducted by:

  • Site / Ward Manager:

  • Date sent to Locality Director:

  • Date sent to Locality Manager:

  • Date sent to Site / Ward Manager

Cover Sheet

Site Information:

  • Ward / Department:

  • Risk Code Factors for Type of Ward/Client/Patient Group:<br>Emergency Department<br>Wards<br>General Outpatients<br>Short Stay/ Day Surgery <br>Intensive Care

  • Conducted on:

  • Personnel / Department Involved:

Ligature 1

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW<br><br>

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 2

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • 2Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW<br><br>

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 3

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW<br><br>

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 4

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW<br>

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 5

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW<br><br>

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 6

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 7

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • <br>Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 8

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 9

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 10

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 11

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 12

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 13

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 14

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 15

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 16

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 17

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 18

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 19

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 20

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 21

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 22

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 23

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 24

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 25

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 26

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 27

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 28

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 29

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 30

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 31

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 32

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 33

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 34

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 35

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 36

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 37

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 38

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 39

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 40

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 41

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 42

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 43

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 44

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 45

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 46

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 47

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 48

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 49

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 50

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 51

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 52

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 53

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 54

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 55

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 56

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 57

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 58

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 59

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 60

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 61

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 62

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 63

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 64

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 65

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 66

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 67

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 68

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 69

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 70

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 71

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 72

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 73

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 74

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 75

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 76

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 77

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 78

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 79

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 80

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 81

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 82

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 83

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 84

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 85

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 86

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 87

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 88

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 89

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 90

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 91

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 92

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 93

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 94

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 95

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 96

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 97

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 98

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 99

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Ligature 100

  • Room No / Identifier / Name:

  • Room / MICAD Reference:

  • Select Room / Area Type:<br>5 = Bathroom / Toilet/ Shower<br>4 = Bedroom/ Side room/ Private room/ Clinic Room<br>3 = Quite room/ family room/ Shared ward.<br>2 = Day / Dining Room / Lounge (communal area)<br>1 = Corridor / Waiting area

  • Ligature Anchor Point Description:

  • Select Ligature Height Code:<br>5 = 800mm - 2.2m<br>4 = 500mm - 800mm<br>3 = 2.2 = 3.5<br>2 = 300mm - 500mm = 2<br>1 = < less 300mm or more > 3.5m

  • Ward Type Values (+ / - )<br>Emergency Department +5<br>Wards +4<br>General Outpatients +3<br>Short Stay/ Day Surgery + 2<br>Intensive Care - Divide by 2

  • Enter Risk Grading:<br>(Room / Area Type x Height Code, + / - = Ward Type Value)<br>20 - 30 = HIGH<br>11 - 19 = MEDIUM<br>1 - 10 = LOW

  • Ligature Anchor Point Photo:

  • Any Mitigating Factors?

  • Can the Ligature Anchor Point be removed, replaced or modified YES/NO?

  • If No, can it be managed clinically? If so, how?

Local Action Plan

LOCAL LIGATURE ACTION PLAN

  • Please use the space provided to record any local actions. If you are recording individual actions; please precede each entry with the Ligature number shown in this report along with the location and description.

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