Pregnancy Risk Assessment

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Name of person

  Yes

  No

  N/A

• Is whole body vibration or possible physical shocks, part of the work activity?

  Compliant

  Non-Compliant

  N/A

• Is manual handling part of the job activity?

  Compliant

  Non-Compliant

  N/A

• Is ionising radiation or non ionising radiation a hazard in the job activity?

  Compliant

  Non-Compliant

  N/A

• Are extremes of cold or heat a possible hazard in the job activity?

  Compliant

  Non-Compliant

  N/A

• Is the current workload or pace of work manageable with regard to the stage of pregnancy?

  Compliant

  Non-Compliant

  N/A

• Is there much physical activity involved at a job activities?

  Compliant

  Non-Compliant

  N/A

• Is there the possibility of a hyperbaric atmosphere being present in the workplace?

  Compliant

  Non-Compliant

  N/A

• Is early shift work necessary?

  Compliant

  Non-Compliant

  N/A

• Is evening or night work a feature of the job activities?

  Compliant

  Non-Compliant

  N/A

• Is there any exposure to nauseating smell from chemicals foodstuffs or other substances?

  Compliant

  Non-Compliant

  N/A

• Is there a need to sit or stand for long periods?

  Compliant

  Non-Compliant

  N/A

• Is there any difficulty with leaving a task to use the welfare facilities?

  Compliant

  Non-Compliant

  N/A

• Is there a need for maternity sized personal protective equipment to be provided?

  Compliant

  Non-Compliant

  N/A

• Is the work activity conducted in a tight fitting workspace for example a booth or machine et cetera?

  Compliant

  Non-Compliant

  N/A

• Are infectious conditions a possible hazard in the work activity?

  Compliant

  Non-Compliant

  N/A

• If any Hazard was identified or any question above was answered as yes, please detail any necessary control measures below.

Risk Evaluation

• Severity of Injury

  Select Negligible = 1 Minor injury requiring first aid = 2 Injury requiring time off work = 3 Life altering injury = 4 Fatality = 5

  • Negligible = 1
  • Minor injury requiring first aid = 2
  • Injury requiring time off work = 3
  • Life altering injury = 4
  • Fatality = 5

• Likelihood of exposure to hazard

  Impossible = 1

  Unlikely = 2

  Possible = 3

  Probable = 4

  Definite = 5

• Risk Level

  Very Low = 1 - 5

  Low = 6 - 10

  Medium = 11 - 15

  High = 16 - 20

  Very High = 21 - 25

Conclusion

• undefined