Preston's College ALS Individual Risk Assessment Form

• Learner name:

• Learner EBS number:

• Emergency contact details (name, relationship, contact number)

• Curriculum Area:

• Primary location of learning:

• Course being completed, include description of course content and associated activities:

• Date of initial assessment:

  Date

• ALS Assessor:

• Curriculum Assessor:

Physical and/or sensory requirements.

• Does the learner have any physical or sensory requirements?

  Yes

  No

  N/A
Tap to enter information

• If physical or sensory conditions are identified, the department is required to ensure that a Personal Emergency Evacuation Plan (PEEP) is completed for the individual.

• Restricted mobility/wheelchair user

  Yes

  No

  N/A

• Restricted dexterity/motor skills

  Yes

  No

  N/A

• Visual impairment

  Yes

  No

  N/A

• Hearing impairment

  Yes

  No

  N/A

• Communication difficulties (speech & language)

  Yes

  No

  N/A

• Mental health difficulties

  Yes

  No

  N/A

• Personal care required

  Yes

  No

  N/A

• Access to specialist services (speech therapist, physiotherapy etc)

  Yes

  No

  N/A

• Transport to/from college; transport between sites.

  Yes

  No

  N/A

Medical conditions

• Please specify conditions eg. epilepsy, diabetes, asthma, allergies etc.
  Learner must be present when completing this information.

• Does the learner have any medical conditions that need to be considered?

  Yes

  No

  N/A
Tap to enter information

• Conditions are:

• Date of onset:

• Details of conditions and potential health and safety risks:

• Medication taken:

Hazards encountered in curriculum area:

• Significant hazards associated with the individuals time at college

  Select Hazardous substances Microbiological agents Fire/emergency evacuation Noise Vibration Radiation Extremes of temperature Manual handling Repetitive movements (eg. DSE use) Confined/restrictive spaces Working at height Slips, trips or falls Electricity Pressurised systems Use of machinery Use of vehicles Use of hand tools Violence Lone working Other

  • Hazardous substances
  • Microbiological agents
  • Fire/emergency evacuation
  • Noise
  • Vibration
  • Radiation
  • Extremes of temperature
  • Manual handling
  • Repetitive movements (eg. DSE use)
  • Confined/restrictive spaces
  • Working at height
  • Slips, trips or falls
  • Electricity
  • Pressurised systems
  • Use of machinery
  • Use of vehicles
  • Use of hand tools
  • Violence
  • Lone working
  • Other

Additional actions/control measures/reasonable adjustments:

• Please list any additional actions/controls/adjustments that will be implemented for this learner. Include details of responsible persons for each item.

• 1.

• 2.

• 3.

• 4.

• It is important that this completed document is distributed to all relevant persons (ALS contact, student and department contact).
  
  Distribution details should be recorded below.

• ALS assessor

  Sign

• Learner

  Sign

• Department tutor/personal tutor etc

  Sign

• This assessment is a working document and should be reviewed if the learners condition or circumstances change. All updated assessments should be dated and be forwarded to all relevant personnel.