risk assessment policy2

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Risk Assessment Policy

Document Control Details

Document Lead: Keith ReynoldsRisk Support Services Manager

Ratified By: Joint Health and Safety ForumJoint Risk Management Forum

Document Version Number: 4

Implementation Date: August 2004

Review Date: August 2007 (Latest)


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Table of Contents

Page


Introduction 3

Scope 3

Responsibility 3

Communication of Assessments 4

Policy Review 4

Risk Assessment Guidance

Why assess risks? 5

Definitions 5 - 6

Risk Assessment and Risk Register Process Diagram 7

Who should conduct general risk assessments? 8 - 9

General Risk Assessment Process

Risk Identification 10

Risk Assessment 11 - 18

Appendix A Preliminary Risk Assessment Form (RMPA01) ---------------- 19Appendix B Moving and Handling Checklist (RMSRA01) ---------------- 20Appendix C Self Harm Checklist (RMSRA02) ---------------- 21 22Appendix D Hot Surfaces Checklist (RMSRA03) ---------------- 23Appendix E Physical Security Checklist (RMSRA04) ---------------- 24Appendix F Workplace Checklist (RMSRA05) ---------------- 25Appendix G Lone Working Checklist (RMSRA06) ---------------- 26Appendix H Computer Assessment (RMSRA07) ---------------- 27 30Appendix I Clinical Risk Checklist (RMSRA08) ---------------- 31 32Appendix J Violence and Aggression Checklist (RMSRA 09) ---------------- 33

Appendix K New and Expectant Mothers at Work (RMSRA10) ---------------- 34 35Appendix L Chemicals Checklist (RMSRA11) ---------------- 36


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1. Introduction

The Trust recognises the business and legal reasons for conducting riskassessment. For this reason this policy, with accompanying guidance, sets outits approach to risk assessment. It describes the process, which will befollowed including documentation, which will be used and individualresponsibilities of staff. It also describes how this process will interface withother clinical risk assessment processes. It is important that staff are involvedin the management of risk and reference is made to how staff representativeswill be included in the assessment process.

Finally, the document describes how risks, which cannot be managed at a locallevel, will be communicated to the level of management who can either acceptthe risk on behalf of the Trust or who will take action to reduce the risk. At alltimes staff and their accredited representatives are kept informed of the

current status of the risk.

2. Scope

This policy and guidance will apply to all Trust activities, but will be particularlyhelpful in assessing local risks within services, wards or departments.

Assessments will take into account risks created by the Trust, which couldaffect any person, and in some circumstances property including data. Theterm 'person' will include staff, patients, relatives, members of the public,volunteers, contractors and anyone else who may be affected by the Trustactivities.

Special attention will paid where staff working for different organisations workclosely together for example, contracted domestic workers in a wardenvironment, employees working in buildings occupied by employees of anotherorganisation.

3. Responsibilities

The Chief Executive has overall responsibility for risk assessment within theTrust and for ensuring that effective arrangements are in place to manageidentified risks.

Each Director has responsibility for risk assessment within their areas ofresponsibility and for ensuring that the appropriate level of resources andcommitment are employed in this process. Each Director will monitor theirmanagers in ensuring that appropriate resources are put into place to ensureassessment of their service is conducted.

Directors are responsible for monitoring the results of risk assessments andhave a part to play in allocating resources to manage the risks, which cannot bemanaged locally.


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Each Director will report to the Trust Board, actions taken to address riskassessment, together with their proposed action plans.

Every Trust Manageris responsible for the assessments carried out in theirarea. They will ensure that arrangements are made to:

Train sufficient numbers of local assessors for their area, or attend thetraining themselves, if they chose to carry out their own assessment

Allow sufficient time for assessors to conduct adequate assessment

Consult involve with staff and their safety representatives during theassessment process

Endorse assessments, with or without alteration

Agree local action plans to remove or reduce risks identified during theassessment

Refer risks to the appropriate senior manager or committee where they

cannot be managed locally Make temporary adjustments and keep staffand their representatives

informed of progress in managing risks that cannot be fully managed locally

Review assessments if there is reason to suspect that it is no longer valid orthere has been a significant change.

Identify any member of staff, who is considered to be especially at risk.

Employees' have a duty to cooperate with their managers and local riskassessors when they are conducting risk assessments. They are alsoresponsible for cooperating with their managers in implementing any remedialaction to reduce the risk. Failure to cooperate is a serious matter as this canplace the employee and possibly others at risk.

The Trust has arranged for local risk assessors and managers to havecompetent advice in the risk assessment process from Anglia SupportPartnership's Risk Support Services. Directors and Managers will use thisresource as appropriate.

4. Communication of Assessments

All managers will maintain records of risk assessments which will be brought tothe attention of all employees and contractors who may be affected by the risks,

and the measures they need to take to avoid the risk before they work in thearea.

5. Review of the Policy

This policy will be reviewed no later than once every three years or early ifrequired.


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Risk Assessment Guidance Document

Why do we need to assess risks?

We face and deal with risks everyday, most of the time we assess and manage riskswithout making a formal written assessment. At work we are able to manage the riskourselves without having to refer to others in the organisation. However, there aresome risks, which are beyond our ability to fully understand or control. These risksneed formal risk assessment after which some can be controlled and managed bythe individual or local team, however others may need to be referred to more seniorstaff in the organisation who will decide how to manage the risk.

Definitions

The following definitions are used to assist those involved in risk assessment:Hazard - A hazard is something, which has the potential to cause injury, illness orharm, for example:

1. Cytotoxic drugs are hazardous substances, as they can cause burns to theskin and injure the lungs if inhaled

2. Sharps, such as syringes, have the potential to transmit infection if theypuncture the skin after being injected into another person

Risk - Risk is the likelihood that a hazard will have an adverse outcome with aconsideration of how bad the outcome is likely to be. An example is:

1. A sharps disposal bin left on the floor in a clinic presents a high risk of injury,especially to inquisitive children.

2. Sharps correctly placed in bins which are out of reach, normally pose a lowrisk of injury to children.

Risk Assessment - Risk assessment is a careful examination of what, in your workpractice and area, could cause harm so that you can weigh up whether you havetaken enough precautions or should do more.

Risk assessment of individuals - Assessments of individual patients are carried outby clinical staff and include assessments for moving and handling, pressure sores,mental health (e.g. Care Programme Approach).

Although based on the same principles, this document does not refer to how theseassessments are conducted. However, these are important assessments normallyrecorded in the clinical notes which must be up to date and available for all staff whoneed to know. This will sometimes include non-clinical staff such as porters andsocial carers where information such as safe handling techniques or informationabout aggressive behaviour will be as relevant to them as it is to clinical staff.


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General Risk AssessmentGeneral risk assessments are assessments of specific processes or areas ratherthan an individual person. This document refers to how these assessments areconducted. It is just as important that these assessments are kept up to date andmade available to everyone who needs to know about them. However, reviewperiods will normally be longer than individual assessments, which are reviewedsometimes on a daily basis.

The term 'general risk assessment' may be misleading as perhaps it implies that oneassessment considers all risks in an area, whereas in fact there are probably manygeneral risk assessments. The term 'general' refers to the nature of the assessmentbeing in a wider context than just one individual patient. A general assessment canbe made of the risks of violence and aggression in a department or area, and themeans for reducing the risk. A general moving and handling risk assessment willconsider the normal working environment and the types of handling risks posed tostaff. An individual risk assessment will relate to how a specific patient's mobilityneeds will be managed. Although the two are linked, they are quite different

processes.

The diagram below outlines the risk assessment process.


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Preliminary risk

assessment

Risk assessment

checklist

General riskassessment and

action plan

discussed with

local manager

Trust Board

Local risk

management/

clinicalgovernance

committee

Trust risk

management/

clinical

governance

committee

Refer to line

manager/senior

clinician

Trust Risk register

Further risk

assessments

required?

Risks

identified?

Can risks be

managed

locally?

Can risk be

managed?

Can risk be

accepted or

managed by local

RM committee?

Can risk bemanaged/

accepted by Trust

RM committee?

Yes

Yes

No

No

Yes

Implement risk

action plan

No

No

YesNo

NoYes

Reassess no later

than 2 years.

RISK ASSESSMENT AND RISK

REGISTER PROCESSv3.1 Aug 2004

Can the

residual risk be

accepted bythis person?

No

Report decision/

action to local staffand return risk

assessment

documentation to

local assessor

Yes

Yes


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Who should conduct General Risk Assessment?

Lead Clinicians and Ward/Department Managers must determine locally how riskassessments will be managed:

What activities/tasks will be assessed?

Who will undertake the assessments (see training below)

What will happen with the assessment when it is completed

What action will be taken when needs are highlighted by the assessment

If recommended control measures are beyond the finances of the ward,department or service, what interim measures can be taken to make the taskor environment safer

Agree local action to control the risk while resources are sought from higherlevels of the organisation

How best to share the outcomes of the risk assessment with all staff andothers who may be affected by the risk

Communication with staff on progress in managing risks

How to involve staff and their representatives in assessing the risk

How frequently risks should be re-assessed

Where necessary action is beyond the control of the assessing department,they must be raised with the line manager. However, this does not preventthe local team from taking appropriate temporary action to manage the risk inthe interim

Local Risk Assessors

Local risk assessors may be assigned by ward/department managers to assist themin carrying out risk assessment. This does not remove the managers' legalresponsibility for carrying out assessments. Local assessors are responsible for:

Agreeing with their manager which general risk assessments will be carriedout in the department and the way in which they should be conducted (see

below)

Attending risk assessment training, including update and refresher sessions(see training below)

Conducting risk assessments on behalf of the ward/department manager

Communicating the findings of assessments to staff and their representativeswhen requested by their manager

Keeping copies of assessments available locally

Informing managers when assessments need reviewing


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All Staff

All Staff have a responsibility for managing those risks, which they can and shouldmanage. Acting within their level of competence all staff will manage a situation as itarises. Only as it develops beyond their ability to deal with it will they need to refer totheir line managers or lead clinician. However, it is always good practice to keepmanagers and lead clinicians informed of developing situations.

When they are managing a risk they should communicate the risk and action taken tothose who may be affected by it. For example, staff may identify risks from movingand handling a patient and the appropriate way to manage the patient safely. Theymust ensure that this information is communicated to anyone else who will care forthe patient to ensure consistency of care and safety of members of the team and thepatient or service user.

Everyone has a responsibility to share information about risk as part of a riskassessment. This can include:

Identifying a risk and informing their manager that they believe a formal riskassessment is necessary

Sharing information during formal assessments to establish the level of risk(e.g. how frequently a risk arises, and the potential or actual outcomes)

Making suggestions to managers on how risks could be reduced

Keeping themselves informed of local risk assessmentsby reviewing the riskassessment file held locally

Acting in accordance with the findings of an assessment

Service Managers/Leads

Service Managers and Service Leads are responsible for ensuring that localmanagers conduct risk assessments. This should be monitored as part of the annualappraisal. When head clinicians or ward/department managers have highlighted arisk because they believe it is outside their control, Service Managers/Lead areresponsible for deciding how the risk will be managed. Some options include:

Accepting the risk where they are permitted to do so (refer to Table 3)

Authorising or requesting that the local manager or lead take action

Service manager or lead refers the matter to a more senior manager

Refer the matter to the appropriate committee including the RiskManagement Committee, Health and Safety Committee, Clinical GovernanceCommittee with a full description of the risk and a risk treatment optionappraisal

Await further advice or information before taking action. An example may bethat further risk advice is needed from ASP Risk Support Services, InfectionControl or Human Resources


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Communicate what action has been taken to the local manager/lead Clinicianincluding whether a risk has been accepted.

Risk Management/Clinical Governance Committees

If local Risk Management or Clinical Governance Committees exist in the Trust theyhave the same responsibilities with regard to risk assessment as the Trust-wide RiskManagement/Clinical Governance Committees, except they do not report to the TrustBoard and they only make decisions for the area they represent.

Trust-wide Risk Management/Clinical Governance committees are responsible formanagement of the Trust Risk Register and monitoring progress of risk treatmentplans.

Where Service Managers/Leads are unable to manage a risk due to lack ofresources or the risk is otherwise outside their control, it will be discussed at the riskManagement/Clinical Governance Committee. The committee will consider the

assessment against other priorities on the risk register and the Trust objectives. Adecision will be made and the risk will be entered into the risk register.

Decisions including action plans and any subsequent changes to the plan will becommunicated to the originating local ward or department via minutes of thecommittee.

Ward and departments are responsible for communicating any changes related to arisk on the register to the Trust Risk Management/Clinical Governance committee.

General Risk Assessment Process

1. Risk Identification

Before an assessment can be carried out, risks in the department must be identified.The chart below describes some of the assessment types, which may be useddepending on the context of the area or procedure being assessed.

Identification Method

Context Inspection Nominalgroup

technique

Incidentreports

Maintenancerecords

Department/Physical Area 9 9 9

Procedure/Process 9 9 9

Equipment 9 9 9 9

Inspection of an area will reveal environmental hazards including obstacles, poorsurfaces, poor lighting, unsafe equipment, unsecured hazardous materials.Examples include slippery floors in areas where patients have poor mobility, blindcorners where staff are prone to attack, medications which are unsecured, handlingequipment which cannot be used in areas such as toilets because the doors are notwide enough.


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Nominal group technique involves a group of people identifying what they feel to bethe highest risks within the context of the assessment. The group starts by definingthe nature of the area or process being assessed then either brain storms or 'brainwriting1[1]'.

Inspections can be conducted by an individual, or as a group. Groups can consist oflocal staff, accredited Trades Union Safety representatives or may include peers whowork in another area. They can also include risk specialists such as infection controladvisors, safety specialists, occupational health advisors or Estates staff according tothe complexity of the assessment, the time available and the availability of thespecialists.

Incident review will identify the frequency of certain types of incident as well as theseverity of any outcome. Despite this being a reactive rather than proactive methodof risk identification, it is still a useful tool. Complaint and claim information shouldalso be used to identify trends.

Maintenance record review will identify issues related to facilities and equipment.Frequent repairs of equipment may indicate that either the wrong type of equipmentis being used, or that that staff do not know how to use it. Frequent repairs to thebuilding may identify a hazard such as vandalism or potential for fire.

There are other methods of risk identification if these methods are insufficient, furtheradvice is available from ASP Risk Support Services.

2. Risk Assessment

Risk assessment is a careful examination of the identified hazards to determinewhether and how they could cause injury loss or damage to people or property,

whether enough precautions are in place or whether more should be done.

Once hazards have been identified, the remaining components of the riskassessment are:

Who or what might be harmed and how

How likely it is that an incident would arise from the hazard

How severe would an incident be if one related to the hazard occurred

Judgement of whether the risk is adequately controlled

Risk assessment can be carried out by an individual, or alternatively by a group as

described in the hazard identification stage. When risks are being assessed,consideration should be given to:

All the relevant situations which arise including days, evenings, nights andweekends.

1[1]Brain writing is a very similar technique to brain storming. Brain storming involves the participants

calling out hazards which are then written on a flipchart. Brain writing requires participants to writetheir thoughts on 'Post-it' notes which are gathered together, themed and presented to theparticipants. The advantage of brain writing is that the conversation does not become weightedtowards those members who may normally exert most influence.


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Situations which occur less frequently such as some clinical procedures,maintenance of areas or equipment, adjustment of medical equipment etc.

Unplanned events such as spillages

Emergency situations such as sudden changes in a patient condition

Situations which arise due to changes in weather

Preliminary Risk Assessment

A preliminary risk assessment should be conducted first. This allows the individualassessor or group to determine which risks are so low that they need no furtherconsideration. It is not expected that an assessment will be conducted on everysingle risk that could arise in the area or process. What is important is that the mainrisks are identified and measures put in place to manage them.

A preliminary risk assessment is a way of using the information gathered so far todecide which risks will require further assessment. Form RMPA001 (Appendix A)

should be used to record the general findings.

All participants should be recorded on the assessment form. The manager as theresponsible person should sign the form to acknowledge that they accept the initialassessment as valid. If they do not agree with any part of the assessment theyshould inform the assessor and make alterations. Managers are legally responsiblefor these assessments and consequently for any error or inaccuracy made on them.

The assessor should consider each part of the assessment form and decide whethera further more detailed assessment is required. For example, if an assessment wasbeing conducted in a community dentist service, then a detailed risk assessmentwould not be necessary for bathing, but one would be required for safe moving andhandling if patients often have reduced mobility. In this example, ticks would beplaced under the staff column of the moving and handling row.

Only identified risks ticked on the form will be taken to the next stage, and a formalrisk assessment carried out.

Risk Assessment checklists

A number of checklists have been developed relating to specific themes. These areincluded in the following appendices

Appendix B Moving and handling checklist - Ref RMSRA01

Appendix C Self harm - Ref RMSRA02Appendix D Hot surfaces checklist - Ref RMSRA03

Appendix E Physical security checklist - Ref RMSRA04

Appendix F Workplace checklist - Ref RMSRA05

Appendix G Lone working checklist - Ref RMSRA06

Appendix H Computer checklist - Ref RMSRA07

Appendix I Clinical risk checklist - Ref RMSRA08


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Appendix J Violence and aggression - Ref RMSRA09

Appendix K New & expectant mothers at work risk assessment - Ref RMSRA10

Appendix L Chemical checklist - Ref RMSRA11

Can we see the forms?

These forms should be used to record the significant findings of the assessments.The relevant risk assessment form can be completed by an individual or by a group.The purpose of the form is to lead the assessor to think about sources of risk relatedto a specific theme such as moving and handling or violence.

For example, the environmental risk assessment form will ask the assessor to look ata variety of physical conditions such as floors, lighting or temperature which may leadstaff, patients or visitors to be at risk. Where any risk is identified as beinginadequately controlled, an estimate of the risk rating must be made on the GeneralRisk Assessment form.

General Risk Assessment form

Risks on the focussed form which are considered to be inadequately controlled aretransferred to the General Risk Assessment form Ref RMGRA01 (appendix L).These forms are used to assess the risk rating by asking the assessor to state thelikelihood of the risk occurring and the severity if it does arise.

The assessor starts by recording their details and the date of the assessment.

Description of Activity

A brief description of the area or activity being assessed.

Significant hazards

Transfer the findings from the Focussed risk assessment to this section.

Adverse effects and people at risk

Include the likely adverse effects if an incident were to occur related to this hazard.Although the form states 'People at risk' it can include property including data, orothers.

Number of people affected

This can be difficult to judge, for example six people in an office is straightforwardcompared with hundreds of people approaching a receptionist every day. The bestway to record this is to put it in the context of a timeframe. The assessor shouldremain consistent with this time frame when assessing likelihood later down the form.


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What precautions exist to control the risk

Either record what is already in place to control the risk, or alternatively what can beput in place immediately.

Risk rate

Assess the risk rate by reference to the likelihood and severity charts.

What measures are required?

Indicate the type of action necessary to further reduce the risk. This will betransferred to the risk action plan. Actions need to be realistic and achievable. If arisk cannot be managed locally, reasons should be recorded in this section.

Re-evaluated rate

Reassess the risk on the basis that the recommended action is implemented.

Sign off

The person responsible for the action and the accountable manager must berecorded on the assessment form.

Risks are assessed by comparing the risk severity and likelihood scores against thetables below:

Table 1: Risk Likelihood Scores

RATE LIKELIHOOD DESCRIPTION0 Impossible Could not occur

1 Rare This risk is not expected to recur in our lifetime, e.g. the hazardposed at the start of year 2000

2 Unlikely This descriptor covers those risks that are infrequently occurringHowever it remains a possibility e.g. the re-emergence of some ofthe viruses thought to have been previously eradicated

3 Moderate Risk may re-occur occasionally. You may consider issues thatoccur once or twice a year or less frequently than this

4 Likely Risk will probably re-occur but is not a persistent issue. There areno issues of custom and practice but we know from ourexperiences that the risk does present itself from time to time

5 Certain Risk is frequently occurring. Issues that are a constant threat, or

issues that are identified as custom and practice, would fall underthis descriptor


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Description

APotential impact onindividual(s)/ familymembers, visitor,contractor, staff member

BPotential impact on organisation + resourceimplications ***

CNumber of personsaffected at one time

0 Negligible No real risk of harm (physicalor psychological)

No real increase in risk exposure

No real risk of damage

No real risk of public concern / complaintNegligible financial loss < 500

N/A

1 Minor Minor risk of harm (physicalor psychological)

Minor increase in risk exposure

Minor risk of damage

Minor risk of public concern / complaintMinor financial loss < 5K (think increased beddays, think theft, think damaged equipment, thinkcompensation)

N/A

2 Moderate Risk of temporary injury orillness physical orpsychological (e.g. staffsickness of less than 3 days,injury that will resolve within amonth)

Some risk of property damage (broken chairs,windows, room closure)

Some loss of user/patient confidence, smallrisk of User Complaint

Minor financial loss 3 days < 20 daysLoss of service user confidence, Probablecomplaint +/- adverse publicitySignificant property damage (e.g. requiringward/service closure)Moderate financial loss >10K - 20 daysBreach of legislation or other formal RegulationPublic outrage, Loss of Public ConfidenceTemporary Service closureRemoval of royal college training statusMajor financial loss >250K - 500K

Many >50 e.g.Vaccination error;Screening errors /failure to recall


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Table 2: Risk Severity Scores

Where a risk falls into more than one category of severity, the highest score must beused. So for example if a risk would result in permanent injury (4 Major), Regulatoryauthority intervention (Critical 4) and affect moderate numbers of people (moderate3), the highest score of 4 will be used.

From the severity and likelihood rates a risk rating can be established and should berecorded on the assessment form. Next to the risk rating column, a risk rankingshould also be recorded using the categories in the key.

Table 3 - Risk Scoring Table

LIKELIHOOD

CONSEQUENCES Impossible0

Rare1

Unlikely2

Moderate3

Likely4

Certain5

Negligible - 0 0 0 0 0 0 0Minor - 1 0 1 2 3 4 5Moderate - 2 0 2 4 6 8 10Serious - 3 0 3 6 9 12 15Major - 4 0 4 8 12 16 20Critical - 5 0 5 10 15 20 25

KEY: No risk Low risk Moderate risk Significant risk High risk

Acceptance level Employee Local manager Service Manager Director/Trust Board

Action Plan and Risk Register

An action plan should be prepared after an assessment has been made. Studieshave shown that training is a relatively ineffective method of control, and thereforeshould only be considered after other methods. A general guide on the effectivenessof controls is in descending order of effectiveness:

Eliminate the risk

Substitute the risk activity with a less risky method

Use physical barriers to prevent the escape of energy which would lead to injuryloss or damage

Use procedural methods to prevent the injury loss or damage

Protect at source the person, property or data from loss

Training in safe ways of working

When considering the appropriate control to use, the selected control will be:

Based on active consideration of the options for controlling that risk to andacceptable level of residual exposure;

Promulgated to all those who need to know about the controls;


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Regularly reviewed to consider whether they continue to be:

oEffective

oThe best value for money response to the risk

oDocumented by the relevant managers

If line management are unable to manage the risk, it should be referred using theform to the local risk management committee where it exists or the Trust riskmanagement committee.

The risk should be presented to the committee along with other risks on the riskregister at the same time, and a comparison drawn. The Trust committee shouldcompare the risks against existing by either considering the position on the register,or by comparing the relative costs of reducing risks on the register. For example arisk in the category 'High' with a score of 16 may cost 10,000 to reduce to the levelof moderate with a score of 6. This may be compared to a risk in the category 'High'with a score of 20 which costs 500,000 to reduce to the level of 'moderate' with a

score of 9. On a cost-benefit argument the committee may decide to approve controlfor managing the first risk rather than the second.

Inter-dependencies between risks will be described in the risk register for all risksrated High or above.

Communication

At all stages of the assessment it is important that those who were first involved inassessing the risk are informed of decisions relating to the management. Thisshould be through line management, team meetings and feedback from therespective committees.

Staff should have access to records of the assessment in a risk assessment folderwhere preliminary, focussed and general risk assessments with agreed action plansare stored. These records should be shared with staff working in the department andfor new staff, including temporary and agency staff.

Training

Managers and local risk assessors will be offered training in their roles. This willinclude reference to the need for risk assessment, explanation of the riskmanagement process, description of the risk assessment forms, more detailedinformation about the types of risks which require assessment, how risks arecommunicated throughout the organisation and the importance of feedback.

Assessors will be required to attend refresher courses bi-annually.


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Reassessment

Risks will be reassessed whenever there is a significant change in the way clinical ornon-clinical procedures or environment occur. If there has been no significantchange, risk assessments will be reviewed no less than every two years.

Review

This guidance will be reviewed every year.


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RMPA01 APPENDIX APreliminary Risk Assessment form

Ward/service Date of assessment

Names of those involved in the assessment

Ward/Service Manager name

To be completed by ward/service manager I accept the findings of this assessment:(makeamendments if required before signing)

Signed Review assessment date

Description of area including details of patient type (where appropriate), nature of activities carried out in the area

Risk assessment

The following areas require a full generalassessment of risk

Staff Patients Contracted

staff (e.g.domestics)

Others

incvisitors

Property

Bathing (scalding)

Clinical risks i.e. risks arising out of theprovision of clinical care, e.g. bloodtransfusion, medication, medical devices,absconsion, communication of clinicalinformation, infection

Environmental including fall from a height,slips and trips

Fire, including arson

Hazardous substances including chemicals,legionella, mercury, asbestos

Hot surfaces

Lone working (other than violence andaggression - see below)

Moving and handling

Repetitive strain injury e.g. from use of VDUor ultrasound

Personal protective equipment e.g. masks,gloves

Security of building or property

Violence and aggression and self harm

Other (Please specify)

Version 6 Dated Aug 04


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RMSRA01 Appendix BMoving and Handling Checklist




To be completed by ward/service manager I accept the findings of this assessment:(amend as necessary before signing)


Adequacy ofexistingcontrols

Risk being considered

Adequate

Inadequate

Not

applicable

Risk assessmentreference number(from general

assessment form)

Are particularly heavy loads being carried

Do patients/clients require manual handling

Do staff assist patients/clients to stand/walk

Do we provide assistance to patients/clients duringtransfers

Do we provide assistance in bathing the patients/clients

Are loads dangerous sharp, bulky, unstable, hot or coldDoes staff lift while twisting

Do staff bend forwards or sideways while lifting orcarrying

Do staff need to hold loads out at a distance

Is there a risk of sudden movement

Are surfaces liable to cause slips or trips

Do space constraints preventing good technique

Are objects stored on the floor/above shoulder height

Is there repetitive manual handling

Are loads being carried a long distanceCan staff get a good grip of the load

Are there enough members of staff to carry out the tasksafely

Other



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RMSRA02 Appendix CSelf Harm Checklist




To be completed by ward/service manager I accept the findings of this assessment:


Adequacy ofexisting controls


Adequ

ate

Inadequate

Not

applic

able

Risk assessmentreference number(from generalassessment form)

Describe the type of client and departmentalapproach/ethos to preventing self-harm:

Drugs Securely stored and access keys managed

Drugs Administration, storage, stock checking,disposal, which are communicated and followed by allrelevant staff

Drugs Procedures in place for use of patients ownmedication

Chemicals e.g. cleaning Securely stored

Chemicals suitable quantities taken into patientareas

Sharp objects access controlled to knives, kitchenimplements, cutlery, glass, crockery, razors etc.

Sharp edges on furniture, doors etc


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Ligature points e.g. access to cords, curtain rails, hooks ofany description, door closure mechanisms, door hinges,light fittings, shower heads and fittings, towel rails,mechanisms in windows, clothes rails in wardrobes,handles of any type, anything hanging from the ceiling e.g.

sign boards

Falls from windows, drops greater than 2m etc

Mechanical equipment e.g. Hoovers, cleaning equipment

Electricity e.g. radios, kettles, light fittings, sockets.

Electric circuits protected by RCDs (Residual circuitdevices).

Ignition sources e.g. cigarette lighters, matches andcombustible materials e.g. bedding, books etc.

Trapping points in doors, windows etc

Water risks of drowning, e.g. baths

Other

Note: This is not a complete / comprehensive list of potential risk areas of self harm, and isonly considered to be a guide to assist with the risk of self harm within a unit / location.



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RMSRA03 Appendix DHot Surfaces Checklist






Risk being consideredAdequacy ofexisting controls

Note: Always check for local policies re Safe bathing.

Adequate

Inadeq

uat

e Not

applica

ble

Riskassessmentreferencenumber (fromgeneralassessmentform)

Items which may be touched or handled:

Ovens/Cooker/Microwave/Toaster/Kettle

Laundry iron

Tea boiler/water heater/Coffee machine

Sterilizer

Hot taps

Surfaces which may be leaned/trapped against

Radiators

Exposed hot pipes e.g. for radiators

Electric heaters

Other



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RMSRA04 Appendix EPhysical Security Checklist







Risk being consideredAde

quate

Inad

equate

Not

app

licable


External environment: locks, lighting, view holes, alarmsystems

Poor external lighting

Overgrown landscaping (bushes, trees etc)

Blind corners

External physical security

Too many entry points

Unsecured doors and windows

History of vandalism or break inInternal physical security

Unsecured valuable property e.g. cash, drugs, ITequip

Property not recorded

No alarm system

Lack of vision panels on doors

Poor internal lighting

Isolated areas of the building

Valuables on view to the outside

Internal procedural security

Other



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25

RMSRA05 Appendix FWorkplace Checklist








Adequate

Inadequ

ate

Not

applicab

le


Light levels too high, too low or there is glare

Temperature too high or too low

Poor ventilation not enough or draughty

Hot water

Cold surfaces

Hot surfaces

Confined spaces

Surfaces liable to cause slips or trips

Working at height

Obstructions such as low ceilings

Risks of falling objects or objects too high to safely handle

Working with gases

Working with or near dusts, including asbestos

Electrical cables and equipment

Pressurised equipment e.g. pumps, cylinders

Moving parts of equipment

Space to move around the areaSegregation of people from traffic

Other

Version 5 dated Aug 04


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26

RMSRA06 Appendix GLone Working Checklist








Adequa

te

Inadequate

Not

applicable


Home visits arrangements are in place for:

First time visits

Follow-up and ongoing visits to known risk client/area

Monitoring staff itinerary

Work in poor lighting or visibility (e.g. winter months)

Emergency contact

Animals

Carrying cash or drugs

Visits to isolated areas/communities

Vehicle breakdown

Clinics/surgeries arrangements in place for:

Protection of lone staff/staff in isolated parts of thebuilding

Protection of staff in isolated clinics/surgeries

Working in clinics in a known risk area

Facilities staff (in addition to the above checklist) arrangements in place for:

Hazardous tasks incl work with chemicals or gases

Electrical work

Working at height

Other



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27

RMSRA07 Appendix HComputer Assessment

Name: Job Title:Location: Organisation:Assessor: Date:

Section 1, User Assessment

Tick as applicable Points

1. Is the use of DSE* a prime function of thejob?

YesNo

30

2. How frequently is the DSE used? Every dayMost daysEvery 2/3 daysWeeklyOccasionally

54321

3. How many hours a day (on average) isthe DSE used?

Over 4 hours2-4 hours1-2 hours30 minutes 1 hourUp to 30 minutes

54321

4. How many hours a day of continuous keydepressions?

Over 4 hours2-4 hours1-2 hoursUp to 1 hour

10821

5. Does the job require formal typing skills? YesNo

30

6. Can regular breaks be taken at the Usersdiscretion?

YesNo

03

*DSE = Display Screen Equipment Total points

Score Classification Priority for change13 or less Low risk user Low, make any easy changes now

14 - 18 Medium risk user Medium, make any easy changes now

19 or more High risk user High, arrange to make changes ASAP

Please note that this is not a definitive calculation of risk and is purely a guide to yourassessment

Version Aug 04 FORM TO BE RETAINED BY MANAGER


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28

Section 2, Computer assessment

Yes NoAdditional information /Recommendations

1 User position

1.1 Is the User facing the keyboard andscreen?

1.2 Are the Users eyes level with the top thirdof the screen?

1.3 Is the keyboard and mouse within easyreach?

1.4 Are the Users arms fore-arms roughlyhorizontal and at right angles to theirupper arms?

1.5 Is the User sitting upright?

1.6 Can user rest his/her feet comfortably onthe floor without a footstool? (If no a

footstool is required)

2 Chair

2.1 Is the chair back adjustable?

2.2 Does it give firm support to the lower andmiddle part of the back?

2.3 Does the chair base have 5 feet?

2.4 Is the chair height adjustable?

2.5 Are armrests in position?

2.6 Do they inhibit the user?2.7 Adequate padding on chair?

2.8 Wide enough to seat large members ofstaff comfortably?

2.9 Deep enough to support legs of tallpeople, but not too deep for shorter users(leading to the back-rest not being used).

2.10 Is the chair surface hollowed or deeplyshaped, making it harder to get up orchange position?

2.11 Is the front of the chair rounded over?

3 Workspace

3.1 Allows flexible arrangement of screen,keyboard, mouse etc ?

3.2 Adequate clearance underneath theworkspace for thighs, knees, lower legs &feet ?

3.3 Does it have a low reflective surface?


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29

Yes No Additional information /Recommendations

3.4 Is there adequate space for paperwork?

3.5 Are there any distracting noises?

3.6 Heat (min 16C)?

3.7 Ventilation adequate?

3.8 Access / egress re disabled users?

3.9 Are there any tripping hazards? (Trailingcables/loose floor tiles)

3.10 Walkways clear?

3.11 Is the telephone easy to reach? (If theUsers right-handed the phone should beon their left side and vice versa)

4 Lighting

4.1 Adequate?

4.2 Is there glare or reflections on the screen?

4.3 Are blinds/curtains available to reducethis?

5 Keyboard

5.1 Is the angle of tilt adjustable?

5.2 Are the characters legible?

5.3 Is it comfortable to use?

5.4 Is it too far back from the edge of the desk,causing user to haunch over?

5.5 Is it in front of the user, with at least 50mmof space in front of the keyboard to allowfor hand/ wrist support?

5.6 Are the Users wrists in line with theirforearms?

6 Mouse

6.1 Fits hands comfortably?

6.2 Works efficiently?

6.3 Located adjacent to the keyboard?

6.4 Is the operator using the mouse correctly?


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30

Yes No Additional information /Recommendations

7 Screen

7.1 Can the screen swivel and tilt?

7.2 Does it have a stable image?

7.3 Are the characters clear?

7.4 Is it clean?

7.5 Brightness and background of the screenadjustable?

8 Document Holder

8.1 Does the User input text from paper on aregular basis? (if yes, a document holderis required)

8.2 Is it correctly positioned?

9 Software

9.1 Is the software appropriate for the task?

9.2 Is the mouse required frequently?

9.3 Can shortcut keys be used?

9.4 Has the User been trained to use thesoftware?

10 Individual Conditions

10.1 Does the work routine allow for regularbreaks or changes of activity?

10.2 Does the User suffer from regularheadaches?

10.3 Does the User have back problems?

10.4 Does the User get blurred vision regularly?

10.5 Does the User get sore eyes regularly?

10.6 Does the User know if they need glassesfor DSE use?

Users signature DateAssessors Signature Date

Managers nameSignatureDate received Date actioned

Please note that this is not a definitive calculation of risk and is purely a guide to yourassessment

Version Aug 04 FORM TO BE RETAINED BY MANAGER


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31

RMSRA08 APPENDIX IClinical Risk Checklist







Risk being consideredAdequ

ate

Inadequate

Not

applicable

Riskassessmentreferencenumber (fromgeneralassessmentform)

Blood

Transfusion policy

Handling arrangements

Training

Sharps handling and disposal

Consent

Clear guidance on when written consent required

Information for clients

Competence of staff gaining

Training

Staff competency

Staff registration recorded and up to date

Clinical supervision

Training records and plans

Clinical record keeping

Standardised records

Accessible to relevant staff

Confidentiality

Adequate storage

Retrieval

Policy

Audit

Resuscitation

Clear policy and procedure

Equipment suitable, available and checked

Clear links and liaison with crashteam/ambulance

Training


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32

Medical devices and equipment

Suitable for tasks

Records of equipment and trace ability

Information on safe operation

Training for staff

Maintenance arrangements

Fault reporting Local procedure for Safety Action Broadcasts

Medicines and vaccine

Prescribing

Safe storage/carriage

Dispensing arrangements (convenience and safetyof container)

Information and warnings for user

Administration

Disposal of waste drug/vaccine

Mental health specific:

Standards of Observation on In-patient Wards

Leave for Informal Patients Policy

Communication of Risk (to other Agencies andServices) Policy

Policy on Non-attendance

Policy on Absconsion

Policy on Non-compliance with TreatmentRegimes

Use Trust approved Care Pathway Approach

Maternity specific:

Maternity Profile

Maternity Risk Strategy Guidance for Obtaining Consultant Advice

Guidance for Transfer to Acute setting

Terms of Reference and minutes of the LabourWard Forum

Policy for CTG training



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33

RMSRA09 APPENDIX JViolence and Aggression Checklist








Adequate

Inadeq

uate

Not

applica

ble

Risk assessmentreferencenumber (fromgeneralassessment

form)

Physical security

Good lines of sight e.g. cannot walk into blind spotsincluding rooms without seeing in first

Escape routes for staff in high risk areas

Suitable protection in reception areas

Adequate lighting

Potential missiles

Information

Appropriate signage including Chief Executive notice

on aggression to staff Clear and easy to follow signage

Staff clear about when and how to inform patients ofdelays

Letters give enough detail about visits

New carers/patients given information about thearea, visiting times etc

Action in case of violent incident:

Clear procedure

Means of raising the alarm, attack alarms etc

Clear identification of incident location

Responding staff trained and up to date in their role

Procedure for obtaining further assistance e.g. securityor police

Training

Customer care

Challenging behaviour

Breakaway

Restraint

Other



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34

RMSRA10 Appendix K

New and Expectant Mothers at Work Risk Assessment

Surname First Name DoB

Managers name (please print) Contact Tel:

Department:

Occupation: Hours of work

Please select as appropriate: Please select if is currently pregnant:Expected date of delivery:No. of weeks pregnant:

Work Activates (Attach job description if possible)

Hazards Identified Control Measures implemented &Recommendations

PHYSICAL

BIOLOGICAL

CHEMICAL

WORKING CONDITIONS

Additional information


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35

Are there adequate and suitable facilities for rest breaks? YES NO

Is the employee able to take sufficient rest breaks duringher shift?

YES NO

Has the employee been issued with any medical adviceby a medical practitioner/midwife?

YES NO

If yes, refer immediately to the Occupational HealthDepartment.

Has the employee any concerns about their health? YES NO

If yes, refer immediately to the Occupational HealthDepartment.

Date of Assessment: Review Date:

Assessors Name: Signature:Employees Name: Signature:

To be completed by ward/Service Manager: I accept the findings of this assessment


Copies to Employee

ManagerOccupational Health Department (OHD)

OHD contact details: North Cambridgeshire & Peterborough53 Thorpe RoadPeterboroughCambridgeshirePE3 6AN

Tel: 01733 316519 Fax: 01733 316529

Maternity form v 2/8/04


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RMSRA11 APPENDIX LChemicals Checklist








Adequa

te

Inadequate

Not

applicable

Risk assessmentreferencenumber (fromgeneralassessmentform)

Biological agents e.g. clinical waste, sharps

Cleaning agents e.g. bleach

Dental compounds

Disinfectants

Fixing agents e.g. formalin

Fuel / Maintenance oils e.g. diesel, grease

Gases e.g. carbon dioxide

Latex e.g. gloves especially powderedLiquid gases e.g. cryotherapy

Mercury e.g. thermometers, sphygmomanometers

Paints / resins e.g. used in Art Therapy

Significant dusts / fibres e.g. concrete, wood

Smoking

X-ray chemicals

Other


risk assessment policy2

Documents