Expectant Mother Risk Assessment form

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With respect to expectant and new mothers, the most effective way of complying to Management of Health and Safety at Work Regulations 1999 and Workplace (Health, Safety and Welfare) Regulations 1992 in the UK and Pregnancy at Work Regulations 2007 in Ireland, is to complete a risk assessment. A risk assessment with the expectant mother is to be carried out twice during the pregnancy and once upon their return to the workplace UK guidance note from the HSE is available at this address:
https://www.hse.gov.uk/mothers/employer/risk-assessment.htmand Ireland guidance note is available here https://www.hsa.ie/eng/Publications_and_Forms/Publications/Safety_and_Health_Management/Section_6_Pregnancy_at_Work.pdf
Person being Assessed
Assessment
Location
Assessment Date
Any current health issues
detail health issues to be considered
Review Date
Assessor (name)
Assisted by (names)

Hazard List

Each of the six hazard sections must be considered when completing this risk assessment
Select your Hazard
- Workstation
- Manual Handling
- Travelling for work
- Hazardous Substances
- Hazardous Processes
- Welfare
Any manual handling tasks should be limited - Significant manual handling tasks should be eliminated
Consider the weight of her handbag, laptop bag etc. - Specifically carrying bags on stairs – ensure handrail is used
Source of Hazard
- No manual handling associated with role
- Boxes of paper
- Boxes of product
- Movement of furniture
- Using Pallet/ Pump truck
- Carrying bags - IT Equipment
- Any other
Current existing controls (include discussion in the notes and any improvements to be added as an 'Action')
How much is the likelihood of occurrence of hazard
What could be the severity of Injury (e.g. back injury, muscle strain) / Disease (e.g. work related upper limb disorder)
- Very minor injury, insignificant damage
- First Aid Injury, minor loss of process, slight damage
- Lost time injury, loss of process, limited damage
- Reporting Injury, critical loss of process/damage
- Fatality,catastrophic loss of business
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Commuting - record the length of time it takes - Visiting branches/ customers – advise no longer than 2 hour drive
Second assessment – advise reduction of driving times
FLT Driving in the warehouse – consider eliminating due to accessing the cab
Source of Hazard
- Commuting
- Customer visits
- Branch visits
- No driving
- No flying
Length of journeys
Frequency of journeys
Current existing controls (include discussion in the notes and any improvements to be added as an 'Action')
Advise the use of a bump belt . Protects baby and mother in case of harsh breaking/ an accident - Re-useable and temporary attachment to the car seat - available on-line
How much is the likelihood of occurrence of hazard
What could be the severity of Injury/ Disease
- Very minor injury, insignificant damage
- First Aid Injury, minor loss of process, slight damage
- Lost time injury, loss of process, limited damage
- Reporting Injury, critical loss of process/damage
- Fatality,catastrophic loss of business
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
If the use of hazardous substances are used at work, a COSHH assessment must be completed. Contact the H&S department for additional advice on use of hazardous substances whilst pregnant.
Source of Hazard (include name of the hazardous product/s they are using)
Do COSHH assessments existence and has the expectant mother read them?
Contact H&S to support if the expectant mother uses hazardous substances and no COSHH assessments exist
Ask the expectant mother to show where she has read the COSHH assessments - e.g. communication form, training etc
Current existing controls (include discussion in the notes and any improvements to be added as an 'Action')
How much is the likelihood of occurrence of hazard
What could be the severity of Injury/ Disease if expectant mother comes in contact with the hazardous substance in an uncontrolled manner
- Very minor injury, insignificant damage
- First Aid Injury, minor loss of process, slight damage
- Lost time injury, loss of process, limited damage
- Reporting Injury, critical loss of process/damage
- Fatality,catastrophic loss of business
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
If hazardous processes are part of the expectant mothers regular work tasks, please contact the QSHE department for further advice.
Source of Hazard
- Work at height
- Operating machinery
- Hot work (welding, grinding etc)
- Low temperature work (Perishables)
- No hazardous processes
Working at height is not permitted, inc Stepladders , Step stools, Work platforms
Work at floor level (e.g. on hands and knees) should also be limited
Select likelihood as 'improbable' and severity as 'very minor' and include any discussion in existing controls
Existing Controls Current existing controls (include discussion in the notes and any improvements to be added as an 'Action')
How much is the likelihood of occurrence of hazard
What could be the severity of Injury/ Disease
- Very minor injury, insignificant damage
- First Aid Injury, minor loss of process, slight damage
- Lost time injury, loss of process, limited damage
- Reporting Injury, critical loss of process/damage
- Fatality,catastrophic loss of business
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Source of Hazard
- Computer Workstation
- Packing station
- Manual handling Equipment (FLT, PPT)
- Other
Please first go and complete the risk assessment for Display Screen Equipment
Has the expectant mother completed a DSE assessment?
Raise an 'Action' for the expectant mother to complete a display screen assessment
Current existing controls (include discussion in the notes and any improvements to be added as an 'Action')
How much is the likelihood of occurrence of hazard
What could be the severity of Injury/ Disease
- Very minor injury, insignificant damage
- First Aid Injury, minor loss of process, slight damage
- Lost time injury, loss of process, limited damage
- Reporting Injury, critical loss of process/damage
- Fatality,catastrophic loss of business
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Is the expectant mother aware of welfare facilities in the location of work?
Consider the location and access of the; toilet facilities, rest facilities, drinking water. Are parking facilities adequate and accessible at the site for the expectant mother?
Upon return to work - consider area to express and store breast milk and any resulting complications reducing mobility
Is the mother breastfeeding?
it is a requirement to provide a breastfeeding mother a safe and private location to express breastmilk during work hours and a suitable and safe location to store it if required.
Current existing controls (include discussion in the notes and any improvements to be added as an 'Action')
How much is the likelihood of occurrence of hazard
What could be the severity of Injury/ Disease
- Very minor injury, insignificant damage
- First Aid Injury, minor loss of process, slight damage
- Lost time injury, loss of process, limited damage
- Reporting Injury, critical loss of process/damage
- Fatality,catastrophic loss of business
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
This is the final hazard section - now progress to sign off page
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?