Expectant Mothers' Risk Assessment ED4

• Expectant Mother Name

• Conducted on

  Date

1. EXPECTANT MOTHER'S DETAILS

• Name

• Expected Date of Confinement

  Date

• Job Title

• Department

• Line Manager

• Hours Worked per Week

• Work Description

• Person carrying out Assessment

2. HAZARDS & WORKING CONDITIONS

• Access to welfare facilities

  Yes

  No

  N/A

• Accompanied

  Yes

  No

  N/A

• Bending

  Yes

  No

  N/A

• Biological Agents

  Yes

  No

  N/A

• Carrying

  Yes

  No

  N/A

• Chemicals

  Yes

  No

  N/A

• Cold

  Yes

  No

  N/A

• Confined Spaces

  Yes

  No

  N/A

• Difficult Access / Egress

  Yes

  No

  N/A

• Driving

  Yes

  No

  N/A

• Excessive Movement

  Yes

  No

  N/A

• Heat

  Yes

  No

  N/A

• Lifting

  Yes

  No

  N/A

2. HAZARDS & WORKING CONDITIONS CONTINUED

• Mental Fatigue

  Yes

  No

  N/A

• Moving Around College

  Yes

  No

  N/A

• Night Work

  Yes

  No

  N/A

• Noise

  Yes

  No

  N/A

• Overtime

  Yes

  No

  N/A

• Physical Fatigue

  Yes

  No

  N/A

• PPE

  Yes

  No

  N/A

• Queueing

  Yes

  No

  N/A

• Radiation

  Yes

  No

  N/A

• Shift Work

  Yes

  No

  N/A

• Shocks/Jolts

  Yes

  No

  N/A

• Sitting

  Yes

  No

  N/A

• Standing

  Yes

  No

  N/A

• Stretching

  Yes

  No

  N/A

• Vibration

  Yes

  No

  N/A

• VDU's

  Yes

  No

  N/A

• Walking

  Yes

  No

  N/A

• Working Alone

  Yes

  No

  N/A

• Working at Height

  Yes

  No

  N/A

3. MEDICAL CONDITIONS

• Are there any pregnancy related medical conditions that we should be aware of? Please detail:-

4. OTHER HAZARDS

• Are there any other hazards that should be considered during this assessment? Please detail:-

5. COMPLETION & NOTIFICATION

• Action Taken / Advice Given

• Expectant Mother advised of HSE link:- http://www.hse.gov.uk/mothers

  Yes

  No

  N/A

• Assessment completed by

• Others notified

  Select Expectant Mother Human Resources Line Manager

  • Expectant Mother
  • Human Resources
  • Line Manager

• Review required

  Yes

  No

  N/A

• Proposed review date

  Date