Pregnancy risk assessment

• Pregnant worker name:

• Conducted on

  Date

• Carried out by

• Answer all mandatory questions with a red line next to them

• Has Donald Russell received written notification of pregnancy?

  Yes (Green)

  No (Red)

• Date received

  Date

• Brief description of duties

• Number of weeks pregnant if known

• Have you had any specific advice from your doctor or midwife?

  Yes (Red)

  No (Green)

• MAT B1 form required after 20 weeks of pregnancy from:

  Employee

  GP

  Midwife

• Date required

  Date

1 - PHYSICAL JOB DEMANDS - Does the work involve?

• Lifting or pushing heavy objects?

  Yes (Red)

  No (Green)

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

• Action to be taken

• Standing for long periods?

  Yes (Red)

  No (Green)

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

• Action to be taken

• A Lot of Walking?

  Yes (Red)

  No (Green)

• Advise employee take regular rest stops and sit down as often is necessary.

• Action to be taken

• Work at height or climbing steep steps?

  Yes (Red)

  No (Green)

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

• Action to be taken

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

  Yes (Red)

  No (Green)

• Advise employee to inform their line manager if and when body shape becomes a problem (I.e. They cannot get close enough to the task)

• Action to be taken

• Is shift / lone working required?

  Yes (Red)

  No (Green)

• Advise employee night working and lone working should be avoided. Allow for flexibility. Limit hours worked.

• Action to be taken

2 - MENTAL JOB DEMANDS - Does the work?

• Require the expectant mother to meet challenging deadlines?

  Yes (Red)

  No (Green)

• 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.

• Action to be taken

• Involve rapidly changing demands and priorities?

  Yes (Red)

  No (Green)

• 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.

• Action to be taken

3 - GENERAL WORKING CONDITIONS

• Require a high degree of concentration?

  Yes (Red)

  No (Green)

• 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.

• Action to be taken

• Do any relevant risk assessments (including DSE) need to be reviewed?

  Yes (Red)

  No (Green)

• Select which risk assessments need to be reviewed or carried out

  Select Manual handling DSE COSHH Task specific PPE Other

  • Manual handling
  • DSE
  • COSHH
  • Task specific
  • PPE
  • Other

• Specify which risk assessment(s) need review

• Are toilet facilities easily accessible to the expectant mother?

  Yes (Green)

  No (Red)

• Try and arrange for toilet facilities to be suitably close to allow toilet break to be taken as necessary or relocate to a closer location if possible

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

  Yes (Green)

  No (Red)

• Ensure a room is always available to take a break if necessary.

• Define what room can be used?

• Can the expectant mother control the pace of work?

  Yes (Green)

  No (Red)

• 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.

• Yes

  No

  N/A

• Is a reasonable temperature maintained in the environment?

  Yes (Green)

  No (Red)

• 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 (Green)

  No (Red)

• Action:

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

  Yes (green)

  No (red)

  Not applicable (grey)

• 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 them to rest when necessary.

• Does the role include any home working?

  Yes (Red)

  No (Green)

• 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?

  Yes (Red)

  No (Green)

• 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?

• Is there any exposure to any of the following?

  Select Harmful substances Fumes Smoke Noise Dust Vibration Ionising Radiation Extremes of temperature Uneven floors Wet/slippery floors Poor lighting No exposure

  • Harmful substances
  • Fumes
  • Smoke
  • Noise
  • Dust
  • Vibration
  • Ionising Radiation
  • Extremes of temperature
  • Uneven floors
  • Wet/slippery floors
  • Poor lighting
  • No exposure

• Occupational Health may be necessary in some cases. Refer this case immediately to HR.

• Action(s) required

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

  Yes (Red)

  No (Green)

• 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

• Is there a need for business travel (select all possible modes of travel)

  Select Road Rail Air Sea No travel

  • Road
  • Rail
  • Air
  • Sea
  • No travel

• Likely destination(s)

• ROAD: Advise employee if undertaking a long journey ensure they leave long enough time for rest breaks.

• RAIL: Advise employee to walk up and down aisles as necessary if feeling uncomfortable.

• AIR: Advise employee to consult their GP & travel agent before booking travel

• SEA: Advise employee to consult their GP & travel agent before booking travel.

• ***Avoid business travel to areas where it is not advised the pregnant women should visit***

• ***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)?

  Yes (Red)

  No (Green)

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

• ****Assessment to be reviewed at request of employee or manager.

• Recommendations & Comments

7 - Declaration

• ***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.***

• Line Manager Sign

  Sign