Section 1 Mothers Details

1. NEW MOTHER'S DETAILS

  • Name

  • Date of Child's Birth

  • Job Title

  • Department

  • Line Manager

  • Hours Worked per Week

  • Work Description

  • Person carrying out Assessment

2. HAZARDS & WORKING CONDITIONS

  • Access to welfare facilities

  • Accompanied

  • Bending

  • Biological Agents

  • Carrying

  • Chemicals

  • Cold

  • Confined Spaces

  • Difficult Access / Egress

  • Driving

  • Excessive Movement

  • Heat

  • Lifting

Section 2 Hazards & Working Conditions

2. HAZARDS & WORKING CONDITIONS CONTINUED

  • Mental Fatigue

  • Moving Around College

  • Night Work

  • Noise

  • Overtime

  • Physical Fatigue

  • PPE

  • Queueing

  • Radiation

  • Shift Work

  • Shocks/Jolts

  • Sitting

  • Standing

  • Stretching

  • Vibration

  • VDU's

  • Walking

  • Working Alone

  • Working at Height

Section 3 Medical Conditions

3. OTHER

  • Are you currently breast feeding?

  • Access to suitable rest facilities available?

  • Access to privacy available?

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

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

4. COMPLETION & NOTIFICATION

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

  • Others Notified

  • Assessment completed by

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