Gwent Wide Integrated Community Equipment Services

Manual Handling Risk Assessment Form

SECTION A: SERVICE USER AND ASSESSOR DETAILS
Name: / SSID/ NHS Number:
Address: / Date Of Birth:
Assessment Date:
Telephone Number: / Assessment Time:
Location of Assessment: (If different to Address)
Name of Assessor: / Designation:
Organisation/Department: / Contact Number:
SECTION B: CLIENT LOAD
Height: / Weight:
Stature: / Small Medium Tall
Reason For Assessment
Any existing equipment: / YES (please specify and check condition) / NO
Are carers present at time of assessment and using existing equipment appropriately? / YES / NO
Mental Capacity / YES / NO (consider Best Interest Decision tool)
Status / Comments
1 / Relevant Medical Condition
2 / Pain Status
3 / History of Falls
4 / Hearing / Vision
5 / Speech (include language, communication)
6 / Skin conditions including tissue viability
7 / Seizures / involuntary movements
8 / Postural stability (include sitting, standing, balance, head control)
9 / Muscle tone/ contractures
10 / Attachments / Prosthetics
11 / Continence
12 / Cognitive / behavioural (include capacity issues)
13 / Day / Night Variations
SECTION C: TASKS
Status / Hazards Identified / Comments
1 / Ability to weight bear / YES / NO
2 / Mobility / YES / NO
3 / Bed - In and Out / YES / NO
4 / Bed - Up and Down / YES / NO
5 / Bed - Turning / YES / NO
6 / Bed - Sitting / YES / NO
7 / Chair – Sit to Stand / YES / NO
8 / Chair – Repositioning / YES / NO
9 / Toileting / YES / NO
10 / Personal Care and Dressing / YES / NO
11 / Bathing/Showering / YES / NO
12 / Stairs/Steps / YES / NO
13 / Other / YES / NO
SECTION D: ENVIRONMENT
Status / Hazards Identified / Comments
1 / Space Constraints (for handler and equipment movement) / YES / NO
2 / Are the floor coverings appropriate to allow ease of movement of equipment to be used? (i.e. corridors / thresholds) / YES / NO
3 / Furniture, i.e. height, suitable for equipment? / YES / NO
4 / Access (e.g. to bed, bath, W/C and passage ways) / YES / NO
5 / Access to Property e.g. Stairs/Steps / YES / NO
6 / Equipment power supply / YES / NO
7 / Sleeping in room with a gas fire? / YES / NO
8 / Is the temperature, Humidity and Lighting adequate? / YES / NO
9 / Pets at property? / YES / NO
10 / Small Children at property? / YES / NO
11 / Other / YES / NO
SECTION E: CARER/HANDLER
Name of Carer Present
Status / Comments
Have named informal/formal carers received appropriate demonstrations of use of equipment? / YES / NO
Is special training required for equipment to be issued? (in addition to foundation training) / YES / NO
Is special equipment and or clothing required? (i.e. gloves, apron) / YES / NO
Are the carers at risk of poor posture during the task? (bending, twisting, stooping, reaching , etc.) / YES / NO
Are there specific hazards to those with existing health problems (or pregnancy)? / YES / NO
SECTION F: RISK REDUCTION PLAN
Concern/Difficulty/Hazard Identified / Action Required / Clinical Reasoning / By Whom / Date Completed
Review Date
Have other options been considered and rejected, if so, please state reasons
1.
2.
3.
SECTION G: Hoist and Sling Compatibility Tool
Does a Hoist and sling compatibility tool need to be completed?
YES / State reason why: / NO / State reason why:
(If No, go to Handling Plan)
Hoist and Sling Assessment
Equipment Assessed With / Make/Model/Size
Hoist:
Sling :
Hoist and Sling Evaluation
Yes / No / Comments
Does the Hoist and sling keep the person at a good & safe angle
Is good posture for the person maintained by the hoist and sling?
Is the distance from the spreader bar to the person acceptable?
Spreader bar and loop compatible
Is there a compatibility statement from either the sling or hoist manufacturer?
YES
If yes please attach to this form. / NO

Signature

Occupational Therapist:

Print name:
Signature:
Organisation/Department:
Designation:
Date:


Gwent Wide Integrated Community Equipment Services

Manual Handling Risk Matrix

(current situation)

Note: You must assess the risk against the likelihood of an incident occurring and should it happen the severity of the consequences.

Likelihood – Please indicate taking into account the controls in place and their adequacy, how likely is it that such an incident could occur?

Level / Descriptor / Description
5 / Almost Certain / Likely to occur on many occasions, a persistent issue
4 / Likely / Will probably occur but it is not a persistent issue
3 / Possible / May occur occasionally
2 / Unlikely / Do not expect it to happen but it is possible
1 / Rare / Can’t believe that this will ever happen

Severity – Please indicate taking into account the controls in place and their adequacy, how severe would the consequences be of such an incident?

Level / Descriptor / Actual or Potential Impact on Individual (s) / Actual or Potential Impact on Authority
5 / Catastrophic / Death / National adverse publicity. HSE investigation. Litigation expected/certain
4 / Major / Permanent Injury: e.g. RIDDOR reportable/ill health/retirement/redeployment / RIDDOR reportable. Long term sickness. Litigation expected/certain
3 / Moderate / Semi-Permanent Injury/Damage: e.g. injury that takes up to one year to resolve or requires Occupational Health / rehabilitation / RIDDOR reportable. Long term sickness. Litigation possible but not certain
2 / Minor / Short term injury/damage: e.g. injury that has been resolved within one month / Minimal risk to Council. Short term sickness. Litigation likely
1 / Insignificant / No injury or adverse outcome / No risk to Council, litigation remote

RISK SCORE / ACTION TO BE TAKEN: (Likelihood level x Severity level)

Likelihood / Severity
LEVEL / 1 / 2 / 3 / 4 / 5
1 / 1 / 2 / 3 / 4 / 5 / Low
2 / 2 / 4 / 6 / 8 / 10 / Medium/Further action required
3 / 3 / 6 / 9 / 12 / 15
4 / 4 / 8 / 12 / 16 / 20 / High / Urgent action
5 / 5 / 10 / 15 / 20 / 25
Service User Name: / SSD/NHS No.:
Date Completed: / Completed by:
Likelihood: / Severity:
Risk Score: / Rating:

MHRAF