Expectant mothers assessment

• Site conducted

  Select

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Brief description of duties

• Number of weeks pregnant if known

• Written notification received of pregnancy?(if yes enter date received)

  Yes

  No

  N/A

• Requested MAT B1 form from employee after 20 weeks of pregnancy(if yes enter date requested)

  Yes

  No

  N/A

• Received MAT B1 form from GP after 20 weeks of pregnancy(if yes enter date received)

  Yes

  No

  N/A

1 - PHYSICAL JOB DEMANDS - Does the work involve?

• Lifting or pushing heavy objects?

  No

  Yes

  N/A

• If yes to above, advise employee to avoid manual handling activities, use mechanical aids/colleague support, reduce load to less than 5kg.

• Standing for long periods?

  No

  Yes

  N/A

• If yes to above advise employee to make sure they sit down as often as they feel is necessary. If you do stand for long periods, have a chair nearby.

• A Lot of Walking?

  No

  Yes

  N/A

• If yes to above advise employee take regular rest stops and sit down as often is necessary.

• Work at height or climbing steep steps?

  No

  Yes

  N/A

• If yes to above advise employee to avoid working at height (e.g. Work on elevated platforms) Use lifts instead of stairs where possible.

• Will any task become more hazardous due to expectant mothers changing shape or size?

  No

  Yes

  N/A

• If yes to above advise employee to inform their line manager if and when body shape becomes a problem (I.e. you cannot get close enough to the task)

• Is shift / lone working required?

  No

  Yes

  N/A

• If yes to above advise employee night working and lone working should be avoided. Allow for flexibility. Limit hours worked.

2 - MENTAL JOB DEMANDS - Does the work?

• Require the expectant mother to meet challenging deadlines?

  No

  Yes

  N/A

• Involve rapidly changing demands and priorities?

  No

  Yes

  N/A

• Require a high degree of concentration?

  No

  Yes

  N/A

• If yes to any of the above advise employee to inform their line manager immediately if they feel their workload is to high and/or is causing stress. Their line manager should discuss this with them and take appropriate action.

3 - GENERAL WORKING CONDITIONS

• Is any relevant DSE Risk Assessment up to date?

  Yes

  No

  N/A

• If no to above please note - DSE RA should be reviewed annually or following a significant change to the workstation.

• Are toilet facilities easily accessible to the expectant mother?

  Yes

  No

  N/A

• If no to above please note - toilet facilities should be suitably close to allow toilet break to be taken as necessary.

• Can the expectant mother take toilet & rest breaks immediately as necessary?

  Yes

  No

  N/A

• If no to above please note - ensure a room is always available to take a break if necessary.

• Can the expectant mother control the pace of work?

  Yes

  No

  N/A

• If no to above advise employee that if the pace of work is causing stress to consult their line manager who should discuss this with them and take appropriate action.

• Is a reasonable temperature maintained in the environment?

  Yes

  No

  N/A

• If no to above advise employee to report any uncomfortable temperatures to their line manager.

• Is there sufficient room for the expectant mother to gain access & to egress to & from the work area?

  Yes

  No

  N/A

• If no to above advise employee to inform their line manager as soon as body shape becomes a problem so that remedial action can be taken.

• If the works is desk work only does the expectant mother have a suitable adjustable chair?

  Yes

  No

  N/A

• If no to above advise employee if their job entails desk work their job should conform to DSE standards. If they do not normally sit to undertake their work a chair should be available for you to rest when necessary.

• Does the role include any home working?

  No

  Yes

  N/A

• If yes to above advise employee to ensure their home working environment is comfortable and that the same display screen practices are observed as would be at work.

• Does the work or additional duties involve dealing with emergencies?

  No

  Yes

  N/A

• If yes to above consider that in the later stages of pregnancy the expectant mothers mobility will be reduced as well will their ability to respond to emergencies. Their emergency duties may have to be considered at this stage.

4 - SPECIFIC HAZARDS - Will the expectant mother be exposed to?

• Harmful substances?

  No

  Yes

  N/A

• Fumes?

  No

  Yes

  N/A

• Smoke?

  No

  Yes

  N/A

• Noise?

  No

  Yes

  N/A

• Dust?

  No

  Yes

  N/A

• Vibration?

  No

  Yes

  N/A

• Ionising Radiation?

  No

  Yes

  N/A

• Extremes of Temperature

  No

  Yes

  N/A

• Uneven Floors?

  No

  Yes

  N/A

• Vibration?

  No

  Yes

  N/A

• Wet/Slippy Floors

  No

  Yes

  N/A

• Poor Lighting?

  No

  Yes

  N/A

• If yes to any of the above Occupational Health may be necessary in some cases. Refer this case immediately to the Health & Safety Manager.

• Will Personal Protective Equipment (PPE) present a problem as the Pregnancy develops?

  No

  Yes

  N/A

• If yes to above consider that if PPE becomes restrictive, uncomfortable or cannot be worn due to the body shape then the task for which the PPE is required should not be carried out.

5 - TRAVEL - Is the expectant mother required to travel on business by:

• Road?

  No

  Yes

  N/A

• If yes to above advise employee if undertaking a long journey ensure they leave long enough time for rest breaks.

• Rail?

  No

  Yes

  N/A

• If yes to the above advise employee to walk up and down aisles as necessary if feeling uncomfortable.

• Air?

  No

  Yes

  N/A

• If yes to the above advise employee to consult their GP & travel agent before booking travel

• Sea?

  No

  Yes

  N/A

• If yes to the above advise employee to consult their GP & travel agent before booking travel.

• ***IN GENERAL LONG DISTANCE BUSINESS RELATED JOURNEYS SHOULD BE AVOIDED WHERE POSSIBLE IN THE LATER STAGES OF PREGNANCY***

6 - OUTPUT RESULTS FROM ABOVE RISK ASSESSMENT

• Is a referral to Occupational Health required ( if applicable based on output of Risk Assessment)?

  No

  Yes

  N/A

• If yes to the above and you feel the expectant mother is at risk in their role please request an appointment with Occupational Health through the HR department.

• ***Please schedule next review date with Expectant Mother (approx 12 weeks from today's date)***

• Select date

  Date

• Recommendations & Comments

7 - DISCLAIMER

• ***I can confirm I have read and understood the above document. I can also confirm that if I experience any issues at all such as discomfort, pain etc. I will inform my Line Manager immediately.

• Expectant Mother Sign

  Sign

• ***I will ensure that the expectant mother named above will be allowed to heed the above advice as appropriate. In addition, I will ensure that the above noted recommendations are implemented as appropriate and will continue for as long as is possible, however will need to be managed and monitored in line with the needs of the business.***

• Conducted by: Sign

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