ࡱ> %` +2bjbjNN ~,,(D4hdtd40+G$h,:ٖ"::+:j:1lX 0o#;*y0ǷJ&&T%TW"yWWWL^WWW::::DHDPdBDP  FOREWORD Under the SHWW Pregnant Employees Regulations, a risk assessment/job assessment must be conducted at departmental level in relation to the impact of work on the person/unborn child. PART (A) PRELIMINARY INFORMATION Employee name:Department:Job title & Function: Expected date of delivery:PART B Job Assessment carried out by:(on behalf of Department Management):Date of assessment: Note: Informed consent is necessary in order to perform a full risk assessment. All information relating to the pregnancy is treated confidentially. It is the responsibility of the employee to notify her Supervisor/Manager of her pregnancy and of any recommendations made by the ҹ޸þ Occupational Health Doctor which are relevant to the employees health and safety (in the context of her work activities). To Be Completed by the Employee: I give my consent for the Department to consult with the following people, where necessary in order to carry out a full pregnancy job risk assessment UCC Occupational Health Physician* yes/no UCC Occupational Hygienist* yes/no Supervisor/manager yes/no Employee signature: ________________________ Date: ______________ * (Via the Health and Safety Office) Note: This information shall be sent to the ҹ޸þ Occupational Health Physician (via the Health and Safety Office). The Occupational Health Physician shall arrange for the employee to visit the doctor and discuss the contents of this assessment from, review the employees condition as necessary and complete Part (C) of this Form. PART (B) GENERAL RISK ASSESSMENT TO BE CONDUCTED BY THE EMPLOYEES MANAGER \ SUPERVISOR IN CONJUNCTION WITH THE EMPLOYEE CONCERNED, WITH A VIEW TO ELIMINATING \ MINIMIZING RISK(S) TO THE PREGNANT WOMAN AND HER UNBORN CHILD AS SO FAR AS REASONABLY PRACTICAL AND TO ENDEAVOUR TO ACCOMMODATE THE PREGNANT WOMAN WITH SAFE ALTERNATIVE WORK ARRANGEMENTS WHERE POSSIBLE \ FEASIBLE SUBJECT TO AS SO FAR AS REASONABLY PRACTICAL PRINCIPLE. GENERAL TASK ANALYSISYesNoComments \ Proposed Departments Actions to eliminate or minimize risksManual handling? Exposure to Chemical agents? Exposure to Biological agents? Exposure to excessive noise? Vibration or shocks? Radiation (ionising or non-ionising)? Excessive cold or heat? Extensive periods/distance of travel? Night work? Fieldwork Requirement to gown up? THE WORKING ENVIRONMENTHazard presentComments \ Proposed Departments Actions to eliminate or minimize risksYesNoDoes the employee work alone? Are there space constraints preventing good posture? Is it necessary to reach over or around obstacles? Is there excessive vertical movement in accessing objects Are there: steps slopes uneven surfaces spillages rubbish or clutter objects to bump into trip hazards snag hazards Is the working environment: too hot too cold Is the operator provided with wet weather and warm clothing? too humid poorly lit dusty or otherwise to obscured unclean working environment odorous windy Are rest facilities available? MANUAL HANDLINGHazard presentComments \ Proposed Departments Actions to eliminate or minimize risksYesNo Does the Manual Handling involve? Holding loads away from trunk? Twisting? Stooping? Reaching up? Large vertical movements? Strenuous pushing/pulling? Repetitive handling? Could the load suddenly move? Is the load shared unevenly between both hands or by one hand only? Is the operator forced to alter her grasp while supporting the load? Could the feet slip?  If pushing or pulling: are the hands positioned on the item being handled above shoulder height below the waist is the distance of push/pull excessive If carrying: is the distance deemed excessive does the load have to be handled up steps or slopes  Is the person working under time constraints? Is any part of the handling event performed whilst seated? Are any mechanical aids involved in the handling event? Does the handling involve team movement techniques? Is the weight of the object more than 5kg and handled from a seated position or more than 16kg and handled in a working posture other than seated? Is the object: Bulky/unwieldy? Are slippery materials or objects being handled? Is an awkward grip involved? Is the load difficult to grasp? Does the load have sharp or abrasive edges that contain hot/cold materials? Is the load unevenly distributed? Can the load shift during handling? Are live animals or persons being moved?  HAZARDHazard presentComments \ Proposed Departments Actions to eliminate or minimize risksYesNo BIOLOGICAL AGENTS Is there likely exposure to biological agents? IF NO PROCEEC TO SECTION ON CHEMICAL AGENTS Is this in the form of: Bacteria? Virus? Is this biological agent included in risk groups 2, 3 or 4 of the Biological Agents Regulations? Is there Personal Protective Equipment provided if required? Is there possible exposure to: Toxoplasma? Rubella virus? Is the pregnant employee immunised against such agents?  CHEMICAL AGENTS Does the task involve: Regular exposure to chemicals? IF NO PROCEED TO SECTION ON PHYSICAL AGENTS Is there exposure to any of the following chemicals: Lead or Lead derivatives? Carcinogens? Mercury or Mercury derivatives? Antimiotic drugs? Carbon Monoxide? Any chemicals listed in the Chemical Agents Regulations? Is there a provision for Medical Surveillance if required? Is there an MSDS available for the Chemical?  HAZARDHazard presentComments \ Proposed Departments Actions to eliminate or minimize risksYesNo CHEMICAL AGENTS (continued) Are the following Risk phrases identified on MSDS for the Chemical to which the pregnant worker is exposed? R40 Possible risk of irreversible effects? R45 may cause cancer R46 may cause heritable genetic damage (mutagen) R61 may cause harm to the unborn child R63 possible risk of harm to the unborn child (teratogen) R64 may cause harm to breast fed babies Is the chemical in: Solid form? Liquid form? Dust particles? Do air tests need to be conducted? If conducted, are the levels below the limit value expressed in the Chemical Agents or other relevant legislation? Is adequate Personal Protective Equipment provided if required?  HAZARDHazard presentComments \ Proposed Departments Actions to eliminate or minimize risksYesNoPHYSICAL AGENTS Shocks/Vibration Does the task involve; Regular exposure to shocks/vibration? IF NO PROCEED TO SECTION ON IONISING RADIATION How frequent vibration? i.e. driving off-road vehicles Excessive movement? Use of hammer, vibrating power tools? Ionising Radiation Is the operator exposed to potential sources of ionising radiation? IF NO PROCEED TO SECTION ON NON IONISING RADIATION If yes is this in Solid form? Liquid form? Dust particles? Are dose limits monitored? If so, are they below the statutory dose limits? Is there the possibility of a pregnant worker being accidentally exposed to radioactive contamination? Are nursing mothers employed in areas where the risk of receiving radioactive contamination is high? Non Ionising Radiation: Is the operator exposed to potential sources of non-ionising radiation? IF NO PROCEED TO SECTION ON NOISE Is the operator exposed to radio-frequency radiation? Is exposure to electric and magnetic fields within statutory limits? HAZARDHazard presentComments \ Proposed Departments Actions to eliminate or minimize risksYesNoPHYSICAL AGENTS (continued) Noise Is the operator exposed to excessively noisy environments? IF NO PROCEED TO SECTION ON MOVEMENT, POSTURES Is noise monitoring carried out regularly in noisy areas? Is the operator provided with ear protection if required?  Movements & Postures Does the task involve periods in excess of 1 hour at a time standing or sitting? Are operators provided with chairs? Are stress mats provided? Are work areas restrictive or confined in space? Are operators required to access ladders/platforms at height?  Does the task require: Agility? Co-ordination? Speed of movement? Balance? Does the task involve high levels of concentration? Are operators required to undertake dual tasks at one time? Does the task involve extensive periods or distance of travel? Does the operator work within pressurised enclosures?  HAZARDHazard presentComments \ Proposed Departments Actions to eliminate or minimize risksYesNoWORKING CONDITIONS Underground Mining Does the task involve underground mining work? Visual Display Units Does the operator use a Visual Display Unit? IF NO PROCEED TO SECTION ON NIGHT WORK Has an ergonomic assessment been conducted? Has the operator been provided with information on the safe use of VDUs? Does the operator have the opportunity to discuss concerns/dispel the myths regarding radiation emissions with a current authoritative advisor? Night Work Does the task involve night work? OPERATORS Is the operator satisfied with: Lighting levels? Working Temperatures? Noise levels? Does the operator feel the task exerts excessive physical or mental pressure? Are break/rest periods adequate? Can the operator vary the tasks at his/her own discretion? Has the operator received information/training on the hazards of the task? Is health monitoring available? Is the operator aware of first aid arrangements?  PART (C) Risk Assessment Recommendations/Conclusions TO BE COMPLETED BY THE OCCUPATIONAL PHYSICIAN BASED ON HIS/HER REVIEW OF THE EMPLOYEES CONDITION, THE UCC PREGNANCY JOB RISK ASSESSMENT FORM AND A CONSULTATION WITH THE EMPLOYEE HERSELF. Employee name:Department:Job title & Function:Expected date of delivery:PART B Job Assessment carried out by: PART C Job Assessment Carried out by DR:   Date of assessment: No modifications necessary to work  FORMCHECKBOX  Modifications to work recommended See detailed report attached  FORMCHECKBOX  Reassignment until______  FORMCHECKBOX  Reassignment (if nursing and having returned to work) until ______  FORMCHECKBOX  Signature: Date: Print name: Position: ҹ޸þ Occupational Health Physician Note: A copy of Part (C) is to be sent to the Health and Safety Office as well as Part (A & B). A copy to be sent to the employee and her College \ School \ Department \ Centre \ Unit.     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