FORM HM26: NEW AND EXPECTANT MOTHERS GENERIC RISK ASSESSMENT FORM

Name……………………………………………………………………………………. / Area/Dept…………………………………………………………………… / Job Title :……………………………………………………….
Assessed by (PRINT)……………………………………………………………… / Signed………………………………………………………………………… / Date………………………………………………………………..
  • This form should be completed between the expectant Mother and their Line Manager and cover all specific aspects of their work,
  • and be regularly monitored and updated throughout the pregnancy period.
  • Any questions or queries can be directed to the Safety, Health and Wellbeing Team:

ACTIVITY OR AREA / HAZARD(S) / LIKELY CONTROL MEASURES / CONTROLS ADEQUATE
Y/N N/A / RESIDUAL RISK
(HML) / FURTHER ACTION NEEDED
Working Conditions / Shift Pattern
Excess hours
Temperature
Excessive standing / Ensure adequate rest periods between shifts
Ensure adequate breaks within the working day
Ensure temperature is suitable or if high ensure adequate facilities and fluid supply is available
When possible seating should be provided. If it is not possible to carry out the work seated then adequate rest breaks must be provided.

HM26 – revised LU (25/08/09)

ACTIVITY OR AREA / HAZARD(S) / LIKELY CONTROL MEASURES / CONTROLS ADEQUATE
Y/N N/A / RESIDUAL RISK
(HML) / FURTHER ACTION NEEDED
Working Conditions cont’d / Enclosed/cramped work area
Lighting
Violence
Travel / Ensure that all work areas have sufficient space to carry out the required task.
Ensure adequate lighting to reduce/remove the chance of slips trips and falls.
Ensure adequate protective measures are in place.
Ensure vehicle allows adequate access/egress and has sufficient room available.
Moving and Handling / Constant/repetitive lifting
Lifting of weights in excess of 10 kg
Moving equipment
Unnatural posture
Carrying loads / Entire workload is adequately monitored to ensure repetitive lifting is NOT required.
Ensure that moving aids are readily available.
Ensure that adequate trolleys are available to erase the need to carry equipment over distances.
Ensure that work area allows sufficient space to remove the need for bad posture and allow regular change of posture.
No loads should be carried (see carrying equipment above)
ACTIVITY OR AREA / HAZARD(S) / LIKELY CONTROL MEASURES / CONTROLS ADEQUATE
Y/N N/A / RESIDUAL RISK
(HML) / FURTHER ACTION NEEDED
Moving and handling cont’d / Loading/unloading equipment from high shelving units.
Accessing items from high/low level. / Ensure suitable stools and/or steps are available
Ensure all equipment is stored correctly to avoid the lifting of heavy objexts from high or low level.
Infections / Chicken pox, rubella and other childhood illnesses / Immunity state. If unknown then staff should not be exposed to people suffering from these diseases. / Infections / Chicken pox, rubella and other childhood illnesses / Immunity state. If unknown then staff should not be exposed to people suffering from these diseases.
ACTIVITY OR AREA / HAZARD(S) / LIKELY CONTROL MEASURES / CONTROLS ADEQUATE
Y/N N/A / RESIDUAL RISK
(HML) / FURTHER ACTION NEEDED
Control of Substances Hazardous to Health / Cytotoxic drugs.
Any substance which could cause harm, in particular substances giving the risk phrase:-
R40 Possible risk of irreversible effects.
R45 May cause cancer.
R46 May cause heritable generic damage.
R60 May impair fertility.
R61 May cause harm to the unborn child.
R62 Possible risk of impaired fertility.
R63 Possible risk of harm to the unborn child.
R64 May cause harm to breastfed babies / Staff should not be involved with the use of any substances unless a full COSHH assessment has been completed and it clearly shows that staff are safe to do so.
Radiation / Ensure adherence to Local Rules.
For pregnant staff :
Ensure such staff are aware of the risk of radiation exposure and the need to report pregnancy in writing as early as possible.
Ensure that after declaration of pregnancy such staff work in an environment where the dose to foetus is unlikely to exceed 1mSv

HM26 – revised LU (25/08/09)