Risk Assessment Policy - the Royal Cornwall Hospitals Trust website...

Document Reference Code RM/006/09This document is only valid on the day of printing:Title:Developed by:Document Definition:Ratified by:Risk Assessment PolicyPauline Claridge, Risk ManagerReviewed by Debra Spear – Health, Safety and Improvement ManagerPolicyTim Archer, Director of Delivery and Performanceon: 16 th March 2009Date to be reviewed:Review arrangements:Document location:See version control tableAuthorB3 Section of the Intranet document library, Trust website1 SummaryThe Trust is committed to complying with the spirit and intent of the Health and Safety atWork Act 1974, subsequent legislation and the requirements laid down by the NHSLitigation Authority and the National Patient Safety Agency to identify, reduce, control andmonitor ALL risks within the Organisation.2 Who this document is relevant to:The document is relevant to all Managers, Health and Safety Leads and all staff workingfor Cornwall Partnership NHS Foundation Trust.3 Related Trust PoliciesLone Working PolicyRisk Management StrategyHealth and Safety Policy StatementCOSHH PolicyMedical Devices Policy 2008Manual Handling PolicyManagement of Violence and AggressionYoung Persons PolicyManagers guide on Maternity: Safe Employment and Risk Assessment – Child CareCoordination TeamManagement and Reduction of Risk of Falls in Hospital Care4 Related legislation and national guidanceDepartment of Health (2000) An organisation with a memory, report of an expert group onlearning from adverse events in the NHS chaired by the Chief Medical Officer, StationaryOffice, London. ISBN 011 322441 9.Department of Health (2001) Building a safer NHS for patients –www.doh.gov.uk/buildsafenhsDepartment of Health (2004) Risk Management Organisational Controls Standard,Standards for Better HealthPage 1 of 70

Document Reference Code RM/006/09NHSLA (2008) Risk Management Standard 5, Risk Management Standard 1, Governance,Criterion 5, Risk Management Standard 3, Safe Environment Criterion 5, Slips, Trips andFallsHealth and Safety at Work Act 1974 – www.healthandsafety.co.uk/haswa.htmManagement of Health and Safety at Work Regulations 1999 –www.legislation.hmso.gov.uk/si/si1999/19993242Control of Substances Hazardous to Health (COSHH) Regulations 2002 –www.hse.gov.uk/lau/lacsNew and Expectant Mothers at Work: A guide for employers HSG122Young People at Work: A guide for employers HSG165Risk Management Working Group (2004): Making it Work – www.hcsu.org.uk5 Training RequirementsIncluded in the training needs analysis6 Equality Impact AssessmentThe Equality Impact Assessment Form was completed on 21 st January 20097 This document replaces:Risk Assessment Policy RM/006/048 Process for monitoring compliance and effectivenessThe completion of suitable and sufficient risk assessments will be the responsibility of eachTeam Leader/Manager, Community Services Managers and Modern Matrons.Monitoring of compliance within services will be the responsibility of the Associate NetworkDirectors through each Network’s Health and Safety and Risk Management Committees.An annual audit will be agreed, implemented and reviewed by the Trust’s RiskManagement Committee. Monitoring compliance within other areas will be theresponsibility of the Risk Management Strategy Group.Version ControlVersion Date Reviewed Changes By WhomSeptember 2013 Expiry date extended to 31 December 2013 as agreed S. Linterby Director of Quality and GovernanceNovember 2013 Expiry date extended to 28 February 2014 as agreedby Director of Quality and GovernanceS. LinterThis document can be accessed and printed via theIntranet Document Library and the Trust WebsitePage 2 of 70

ContentsDocument Reference Code RM/006/091. Introduction ....................................................................................................................... 52. Background ....................................................................................................................... 53 Benefits of Risk Assessment ............................................................................................ 64 Definitions ......................................................................................................................... 65 General Risk Assessment ................................................................................................. 76 Risk Assessment Guide .................................................................................................... 87 Getting Started ................................................................................................................. 98 Specialist Risk Assessment ............................................................................................ 139 Summary ......................................................................................................................... 17Appendix 1 – Risk Assessment Record .................................................................................. 18Appendix 2 – Risk Scoring Matrix ........................................................................................... 20Appendix 3 – Risk Register .................................................................................................... 23Appendix 4 – Steps in doing a Risk Assessment Flowchart ................................................... 24Appendix 5 – Risk Register Process....................................................................................... 25Appendix 6 – Examples/Hazards and Risks, Associated Risk ............................................... 27Appendix 7 – New, Expectant and Breastfeeding Mothers Risk Assessment Process .......... 28Appendix 7a – Risk Assessment Checklist for ‘New and Expectant Mothers’ ........................ 30Appendix 8 – Young Persons Risk Assessment ..................................................................... 38Appendix 8a – Managers/Student Combined Plan Of Work Record Form And Checklist ForYoung Persons ....................................................................................................................... 39Appendix 8b – Example guidelines for Risk Assessments for Managers of Young Persons . 43Appendix 8c – Example guidelines for Risk Assessments for Managers of Catering Staff,Young Persons ....................................................................................................................... 45Appendix 8d – Young Persons combined Risk Assessment and Action Plan form ................ 47Appendix 9 – Display Screen Equipment Initial Checklist ....................................................... 48Appendix 10 – Control of Substances Hazardous to Health Regulations 2004 (COSHH)Inventory and Summary List of COSHH Assessments ........................................................... 52Appendix 11 – Manual Handling Practical Assessment Form ................................................ 53Appendix 11a – Manual Handling Practical Assessment Form: Inanimate Load & PhysicalIntervention ............................................................................................................................. 54Appendix 11b – Manual Handling Guidance for Completing a Generic / Individual RiskAssessment ............................................................................................................................ 55Appendix 11c – Client/Patient Manual Handling Assessment Form ....................................... 56Appendix 11d – Manual Handling ........................................................................................... 60Appendix 12 – Lone Workers pre Risk Assessment Checklist: Working alone in buildings ... 61Page 3 of 70

Document Reference Code RM/006/09Appendix 12a – Lone Workers Checklist: Domiciliary visits .................................................. 62Appendix 12b – T.M.A.V. Training Needs Assessment .......................................................... 63Appendix 13 – Initial Falls Assessment .................................................................................. 64Appendix 14 – Multi factorial Falls Risk Assessment .............................................................. 65Appendix 15 – Protocol for the use of the Multi factorial Falls Risk Assessment Tool ........... 68Appendix 16 – Minimising the Risk of Falls – Environmental Assessment ............................. 70Word versions of the following Appendices can be found on the document library usingkeyword ASSESSMENTAppendix 1 – Risk Assessment RecordAppendix 3 – Risk RegisterAppendix 7a – Risk Assessment Checklist for ‘New and Expectant Mothers’Appendix 8 – Young Persons Risk AssessmentAppendix 8a – Managers/Student Combined Plan Of Work Record Form And Checklist For YoungPersonsAppendix 8d – Young Persons combined Risk Assessment and Action Plan formAppendix 9 – Display Screen Equipment Initial ChecklistAppendix 10 – Control of Substances Hazardous to Health Regulations 2004 (COSHH) Inventoryand Summary List of COSHH AssessmentsAppendix 11 – Manual Handling Practical Assessment FormAppendix 11a – Manual Handling Practical Assessment Form: Inanimate Load & PhysicalInterventionAppendix 11b – Manual Handling Guidance for Completing a Generic / Individual RiskAssessmentAppendix 11c – Client/Patient Manual Handling Assessment FormAppendix 11d – Manual HandlingAppendix 12 – Lone Workers pre Risk Assessment Checklist: Working alone in buildingsAppendix 12a – Lone Workers Checklist: Domiciliary visitsAppendix 13 – Initial Falls AssessmentAppendix 14 – Multi factorial Falls Risk AssessmentAppendix 16 – Minimising the Risk of Falls – Environmental AssessmentPage 4 of 70

1. IntroductionDocument Reference Code RM/006/09Cornwall Partnership NHS Foundation Trust accepts that the nature of its core business as amental health and learning disabilities Trust and some of its work activities may, unless properlycontrolled, create risks to patients, staff and others and will, in accordance to legislation, take allreasonably practicable measures to reduce these risks to an acceptable level. As directed withinlegislation and national guidance, all aspects of risk within the organisations, in accordance withthe Trust’s core objectives will be assessed to determine what further actions are required toreduce risks to people’s safety and to meet any statutory requirements.Corporate accountability for clinical performance and Health & Safety lies at Trust Board level, withthe Chief Executive who takes overall responsibility. Responsibility is further devolved to theDirector of Nursing, Midwifery and Allied Health Professional’s (AHP’s), through its Directorates,Director of Delivery and Performance, Executive Nurse and Networks East and West.On a day-to-day basis Cornwall Partnership NHS Foundation Trust Managers are deemedresponsible for ensuring that risk assessments are carried out, and that appropriate and effectivemeasures to control risks are developed, implemented and monitored. This document is intendedas guidance in meeting this responsibility.In addition to the above, it is the responsibility of each and every individual working at all levelsacross the Trust, irrespective of grade/seniority, to take care of themselves and others. To thisend, individuals must notify their head of department/line manager of any hazard/risk that appearsto be inadequately controlled.2. BackgroundRisk Assessment is a fundamental risk management tool, which forms part of the pro-activemanagement and decision making process in all areas of the Organisation.The focus for Clinical Risk Management within the Trust is the adoption of the national clinical riskmanagement standards through the NHS Litigation Authority Risk Management Standards,Clinical Negligence Scheme for Trusts (CNST).The CNST standards are about best practice in managing clinical risk, improving the quality ofcare we deliver and reducing harm to patients. Evidence is required that robust systems andprocesses are in place and operational across the Trust. Integral within this is the requirement toundertake a Trust wide clinical risk assessment.Section 2 (1) and 3 (1) of the Health and Safety at Work Act 1974 places a general duty on everyemployer to conduct their undertaking in such a way as to ensure, so far as is “reasonablypracticable”, that both employees and persons not in their employment who may be affectedthereby are not exposed to risk to their health or safety. Under the Management of Health andSafety at Work Regulations 1999 (MHSWR), there is an implicit requirement on every employer tomake a suitable and sufficient assessment of:• the risks to the health and safety of its employees to which they are exposed whilstthey are at work; and• the risks to the health and safety of persons not in his employment arising out of, or inconnection with the conduct by him of his undertaking.Furthermore, the Health Services Advisory Committee (HSAC) have laid down a frameworkrequiring that the organisation can demonstrate that it has sound internal control systems in placefor identifying risks relating to the achievement of the Trusts aims and objectives, evaluating thePage 5 of 70

Document Reference Code RM/006/09nature and extent of those risks and managing them effectively, efficiently and economically. Thecriteria applies equally to clinical and non- clinical risk issues and is based on an over-arching RiskManagement standard which provides strict guidance on risk assessment.3 Benefits of Risk AssessmentThe realisation of risk in the form of incidents, accidents or ill health can present substantiallosses, both in human and financial terms. A progressive reduction of risk will produce benefitsnot only in the delivery of clinical care, but also the management of health and safety and thecontrol of unnecessary losses.• Identifies the potential areas within Departments / Networks• Provides a co-ordinated and systematic approach to analysis and managing problemareas• Improves quality and standards of care for patients• Protects patients, staff and the Trust• Meets the requirements within the Trust’s governance framework• Feeds those risks which can not be managed locally upwards to higher levels ofmanagement and into business plans• Ensures a proactive rather then reactive approachBy meeting the criminal law objective, other corporate risk benefits can be achieved including:• Reduction in exposure of the company and key personnel to criminal liability• Reduction in the risk of Directors’ disqualification from office• Reduction in exposure of company and senior managers to civil liability for death or injury• Reduction in financial risks and improved control over uninsured losses (e.g., lost time,repair costs, replacement costs of injured staff and/or damaged equipment, insuranceclaim excesses)4 DefinitionsRisk is the potential for an unwanted outcome, and Risk Management is concerned with theidentification, analysis and control of any circumstances or practices which put patients, staff,visitors, contractors or the organisation at risk of harm or loss.A Hazard is something that has the potential to cause harm. For example this could be asubstance, piece of equipment or a work procedure.Risk is the probability or chance that harm from a particular hazard will occur. The extent of therisk includes the number of people affected, the consequences for them and the impact across theorganisation – the risk represents the consequences (severity) of harm and the likelihood of itoccurring.Harm includes death, bodily injury, ill health and damage to property, plant, equipment or theenvironment.Risk Assessment is defined as “Identifying the hazards present in any undertaking (whetherarising from work activities or from other factors, e.g. layout of the premises) and then evaluatingthe extent of the risks involved, taking into account whatever precautions are already being taken”(MHSWR, 1999).Page 6 of 70

Examples:Document Reference Code RM/006/09HazardRiskRiskHazardHandling clinical wastePossible infection from contaminationLigature PointHarm/self harm may be realised using accessible ligature point5 General Risk AssessmentIn everyday terms, a risk assessment is simply a careful examination of hazards that couldreasonably be expected to cause harm to patients, staff members, visitors and an evaluation of theway in which such hazards might cause harm or loss.Risk assessment applies to all activities, situations and substances. For assessment to complywith all legal requirements it is necessary to:• Identify the HazardsLook for all the hazards associated with the operation of the area under yourresponsibility and of the activities performed within it (see Appendix 6 for guidance).• Decide who might be harmed and howIdentify any groups or individuals – patients, employees or other persons who might beat risk, including pregnant workers, young persons or those with disabilities.• Evaluate the RisksDecide whether the hazard can be eliminated altogether. If it cannot, determine how tocontrol the risk.Consider existing control measures, decide whether the procedure/activity/process should be:• Stopped• Treated i.e., instruction, training, information provision and supervision• Accepted or• TransferredJudge the likelihood or probability of an accident or incident occurring with consideration to thecontrol measures all ready in place. It may be that they are inadequate and require further controlmeasures to manage the risk.The tool for evaluating and ranking is known as the Risk Scoring Matrix, designed in line withnational guidance and can be seen at Appendix 2.The Risk Scoring Matrix assists in quantifying the risk by multiplying the anticipated consequenceof the risk identified by the likely probability of the risk being realised:• Consequence x Likelihood = Risk RatingRecord FindingsUsing the Risk Assessment Record (appendix 1) record your findings of the hazard that has beenassessed. The Risk Assessment Record will be forwarded for escalation/acceptance at theappropriate level as identified on page 2 of the Risk Scoring Matrix.Page 7 of 70

Document Reference Code RM/006/09Safe KeepingThe risk assessment and supporting information should be kept within the area/service assessedensuring that it is available for staff and others to familiarise themselves with its content.Risk assessments that require further resources to control/manage the identified risk will beescalated to form part of the Directorate/Network/Corporate Risk Register via the appropriatenetwork governance arrangements and reviewed by the Risk Management Strategy group bimonthly(see Risk Register process, appendix 5).ReviewIt is a legal requirement to maintain Health and Safety Risk Assessments, collectively they shouldbe seen as a ‘living’ document that is revised periodically or at any such time that there aresignificant changes to a process, activity or the environment.6 Risk Assessment GuideConducting a Risk AssessmentThe tools within this policy are designed to support you and your colleagues to be proactive in:• Identifying the clinical and non clinical risks within your speciality, department or ward• Determining the level of risk that exists• Assessing them for severity• Prioritising those risks requiring urgent attention• Examining the effectiveness of your current practice to manage those risks• Identifying what further measures need to be taken to either reduce or eliminate therisks• Ensuring appropriate actions are taken to their effectiveness monitoredThe basics of Risk Assessment lies in the answers to two fundamental questionsWhat could go wrong? i.e.,• What harm could be caused?• To whom could it be caused?• What hazards exist?• What precautions have already been taken?• What are the chances of it happening? (residual risk dependant on a – d)What further precautions are needed to prevent it happening?• Stop• Treat• Transfer• AcceptPage 8 of 70

Document Reference Code RM/006/097 Getting StartedSee flow chart simplifying the steps of risk assessment – appendix 4Identify the HazardsThe first step in an assessment is identification of hazards/risks. Risk identification requires asystematic process to discover actual and potential areas of risk within yourWard/Department/Area of responsibility.Step 1 – establish your teamA risk assessment should not be conducted in isolation. It requires the input of those with localand wider knowledge, clinical expertise, and a ‘competent’ personThe relevant people are those able to assess the risks, those who are faced with the risks andthose who need to commit time, money, effort or other resources to implement the controlmeasures decided upon. This allows all staff of all grades and those with responsibility for tasks ineach part of a process to be involvedEveryone should be encouraged to participate and contribute to the process, the strength in thisprocess is that each individual will identify issues which are not immediately obvious to others. Tothis end where risks cross organisational/directorate boundaries, representatives from those areasshould be included in the assessment process.Decide who might be harmed and howDivide the process into logical steps, this can be achieved by:• Considering the locations of work: inpatient/outpatient areas, team bases, public areasetc• Consider the people involved: service users/patients, members of staff, visitors, visitingmaintenance engineers/contractors etc• Consider the equipment used: instruments, diagnostic equipment, display screens,lifting equipment, heavy machinery• Consider procedures and systems of work – are they safe?• Consider those known risks that could lead to death, disability or severe distressIgnore trivial scenarios and concentrate on inadequately controlled hazards with thepotential to cause serious harm, affect several people or have a higher likelihood ofoccurrence or repetitionThe way in which this is achieved is non prescriptive. Personal experience of staff is an essentialsource of information to commence the process, however, information that has been gatheredwithin and externally to the Trust may also inform the identification process• Incidents, Accidents and Near Misses• Audit data – internal and NAO• Claims data – complaints• Patient feedback – complaints data• Clinical indicators• External reports – i.e., Healthcare Commission, Confidential Enquiries, HomicideReportsPage 9 of 70

Document Reference Code RM/006/09• Health and Safety Executive (HSE) Audit report• Feedback from the National Patient Safety Agency/Safety Alerts/MHRA alerts• Clinical Negligence Scheme for Trust’s (CNST) Risk Management Standards• Action plans for Standards for Better HealthSpecialised Risk AssessmentPlease note, this list is not exhaustiveWhen identifying ‘who’ may be harmed, it will be necessary to complete specific risk assessmentson vulnerable people in compliance with the Management of Health and Safety at WorkRegulations 1999 (MHSWR) (see section 8).Analysis and PrioritisationHaving identified a number of risks, obviously it will be necessary to prioritise which risks shouldbe dealt with first. This should be dictated by how effective any resulting control measures maybe.Grade each risk using the 5 x 5 Scoring matrix (appendix 2) to determine the potentialconsequences and the likelihood of the risk occurring.i.e., Consequence x Likelihood = RiskReach conclusion within the assessment team s to whether the risks that have been identified arepredominantly clinical, health and safety, organisational or financial and how they fit with theCorporate objectives.Control MeasuresHaving identified the hazard and the risk that it carries, it is necessary to identify• Which control measures are currently in place and whether they are effective• Whether there is something simple that could be done straight away to reduce theidentified risk or• What control measures need to be put in place to further reduce the risk or eliminate italtogetherFurther questions to be asked are• Can the risk be completely eliminated?• Can it be avoided?• Can it be made less likely?• What are the cost implications of introducing or not introducing further controls?The relationship between the cost of controlling the risk and the benefits to be gained mustbe considered. Consideration should always be given to implementing measures that are‘reasonably practicable’Page 10 of 70

Document Reference Code RM/006/09Not all risk reducing measure that lots of resources!• Developing a robust policy or guideline• Organising training on using a piece of equipment• Raising awareness• Tightening up processes of a task• Developing a competency based assessment for a particular techniqueYour Risk Assessment should then be forwarded to the Network General Manager to approve andrecord any actions required to be taken to further ‘control’, reduce or eliminate the identified risk.Risk RankingUse the 5 x 5 Risk Scoring Matrix to reassess the risk rating with the recommended controlmeasures taken into consideration.Risks that cannot be significantly reduced will need to be entered on the Risk Register andescalated by the Network/Service Managers and Modern Matrons through the Networks and up tothe Trust Board if appropriate.Managers and Supervisors are required to ensure the most effective management of Health andSafety. To help them to do this they should ensure in the first instance and where necessary, thatany risks that required significant financial resources to ensure adequate control (i.e.,replacement/upgrading of environment) are placed on the Risk Register AND built into thebusiness planning cycle.Risk RegisterThe Risk Register (appendix 3) is a Trust wide document, which is in place to facilitate monitoring,and the assurance that risks are being managed. It also assists in the assurance thatimprovements of the standard of care provided to patients and promotion of a healthy and safeenvironment for staff and visitors are embedded in the culture of the organisation.The Corporate Risk Register is reported to the Trust Board on a quarterly basis and containssignificant risk faced by the organisation.Risks entered onto the Directorate Risk Registers are reviewed bi-monthly by the RiskManagement Strategy Group.Local Risk Registers are owned and managed at local level and monitored within local governancearrangements.Amendments and updates can be reported using the Risk Register amendment form (appendix 3).Guidance on informing the Risk Register can be seen at appendixDocumentationRisk Assessments and supporting information must be kept safe and available for submission ofevidence as and when required by inspectorate bodies. They are valuable evidence that there hasbeen a systematic process acknowledging risk and the appropriate ways to manage that risk.Page 11 of 70

Document Reference Code RM/006/09Risk TreatmentResponsibility should be taken to ‘treat’ risk at the appropriate level, where further resources,advice or collaboration is required, these should be escalated as described previously. Detailedguidance for action and reporting requirements can be found on page 2 of the 5 x 5 Risk ScoringMatrix.Score Risk Action Reporting Requirements1 – 3 Low Managed through normalcontrol measuresManage at ward / department level4 – 6 Moderate Review control measures Managed by head of Department orequivalent and monitored at Directoratelevel8 – 12 High Treatment plans to bedeveloped, implemented andmonitored15 – 25 ExtremeImmediate action requiredTreatment plans to bedeveloped, implemented andmonitoredManaged within the Directorate, enteredonto Directorate Risk Register andreported to the appropriate Trust Boardsub committee for entry to CorporateRisk RegisterReport to Trust Board, enter ontoCorporate Risk RegisterMonitoringProgress against each action plan will be monitored at Directorate level and progress reports willbe submitted through the Network Governance Process within the Trust and escalated to TrustBoard as required through the Risk Management Strategy Group.Effectiveness of measures put in place will be audited through local Network Governancearrangements.Risk Assessments will be reviewed on an annual basis or any such time that there are significantchanges to a process, activity or the environment.Communicating RiskIt is a legal requirement that where risks have been identified that staff are informed of the risks.Employees have a duty under the Health and Safety at Work Act (1974) to comply with any safetypolicies or procedures put in place to ensure that their actions do not harm the health and safety ofothers and furthermore to protect their own health and safety.Network/Service Managers and Modern Matrons should make this information available withintheir Directorate.Page 12 of 70

8 Specialist Risk AssessmentDocument Reference Code RM/006/09Whilst the majority of Risk Assessments may be undertaken using a General Risk Assessmentrecord (appendix 1), there are occasions/circumstances when a more precisely targetedassessments needs to be undertaken.The MHSWR (1999) require that employers record any group of employees who are identified asbeing especially at risk.New, Expectant and Breastfeeding Mothers Risk Assessment (appendix 7)The Management of Health and Safety at Work Regulations 1999 (MHSWR) regulations 16 – 18relate to ‘new, expectant or nursing Mothers’, as employees who are pregnant who have ‘givenbirth’ within the previous six months or who are breast feeding.‘Given birth’ means delivered a living child or, after 24 weeks of pregnancy, a stillborn child’.NB:It is the employee’s responsibility to notify the employer of her condition, i.e., that she is anew, expectant or nursing Mother. She should do this by producing a Doctor’s or Midwife’scertificate showing that this condition exists. Temporary staff should notify their Agency orBank that they are covered by these particular regulations. Before commencement ofemployment, the Agency should then advise the Trust in writing of the condition.There is a requirement to assess any risk where there could be a danger to the new, expectant ornursing Mother or her baby.It is not (legally) a Manager’s responsibility to attempt to make an assessment for a condition ofwhich they are unaware. This said however, if it were suspected that an employee is pregnantthen it would be unwise to ignore the fact that the condition exists and has to be taken intoaccount.EU directives give a non-exhaustive list of agents for which Risk Assessment should be made onthis group of employees. This includesPhysical• Noise, Shocks• Vibration or movement• Extremes of cold or heat• Radiation (ionising and non-ionising)• Handling of loads entailing risks, particularly of a dorsolumbar nature• Movements or postures, travelling (inside or outside the establishment), mental andphysical fatigue and other physical burdens connected with the activities of theseworkersWhere these agents could endanger the health of the pregnant woman, or her unborn child (Risksfrom infectious or contagious disease in the context of the regulations are risks that are additionalto risks that a new or expectant Mother may be expected to be exposed to outside of theworkplace).Page 13 of 70

Document Reference Code RM/006/09ChemicalControl of Substances Hazardous to Health (COSHH) records should be checked to see whetherany substance that you are using could affect the health of the pregnant woman or her unbornchild. Pay particular attention to chemical marked as ‘mutagenic, teratogenic’ or with risk phrases61, 63 or 64.61 May cause harm to the unborn child63 Possible risk of harm to the unborn child64 May cause harm to breast fed babiesNB:Under the legislation, exposure of new, expectant or nursing Mothers to certain biologicaland chemical agents is PROHIBITED. These include:• Toxoplasmas and rubella virus (unless the pregnant workers are proved to beprotected against such agents by immunisation).• Lead and its derivatives, in so far as these agents are capable of being absorbed bythe human organism.If it is impossible to avoid these three risks to these workers, then there is a course of action thatmust be followed:• If the risk to the new or expectant Mother or her baby cannot be avoided you shouldfirst of all consider altering her working conditions or hours of work to see if you canremove the risk.• If this is not reasonable or it is found that the risk has not in any case been removed,then the Manager must (subject to Section 46 of the Employment Protections(Consolidation) Act (EPCA) 1978) suspend that employee from work, until such time asis necessary to avoid such risk.Further guidance update December 2002, on new and expectant Mothers is contained in New andexpectant Mothers at Work: A guide for employees HSG 122 (available from HSE Books 01787881165 £9.50 June 2003). The table of hazards identified in the EC Directive (92/85/EEC) onPregnant Workers is given in this publication along with the risks and ways to avoid them.The following booklets, both of which cover the maternity suspension provisions are freelyavailable from DTI (tel: 0870 150 2500)PL705 – Suspension from work on medical or maternity groundsPL958 – Maternity rightsIt is also made clear in the closing statement of the Pregnant Workers Directive that ‘it is notintended in any way that pregnancy and childbirth should be equated with sickness’.Risk Assessment of Young Persons (appendix 8)The law requires all employers, including Cornwall Partnership NHS Foundation Trust to assessthe risks to all employees including young workers such as those under 18 years old and workexperiencestudents.Page 14 of 70

Document Reference Code RM/006/09Why?Young workers are seen as being particularly at risk because of their possible lack of awarenessof risks and the immaturity.Who is a Young Person?Regulation 19 of the MHSWR 1999 cover not only employees under the age of 18 but above theminimum school leaving age but also children (i.e., those under the minimum school leaving age)who may do work experience.What does the employer need to do to comply?• Assess the risks to young people before they start work• Take into account their inexperience and lack of training• Address the issues raised in the risk assessment• Provide information to parents of school age children about the risks and control measuresintroduced• Take into account the risk assessment in deciding if there are any areas from where theyoung person should be prohibitedRisk AssessmentThis individual assessment will look at the risks to the young person including:• The layout of the workplace/office environment including lighting• The nature and duration of exposure• The range of the work undertaken• The range of equipment used: computers, electrical appliances• The extent of health and safety training providedThis assessment should be carried out before the young person starts work. Please seeTrust Health and Safety Policy for specific risks, avoidance strategies and restrictions.Further guidance on young workers is contained in Young People at Work: A guide for employersHSG165 (available from HSE Books 01787 881165 £7.95 June 2003)Risk Assessments of Display Screen Equipment (appendix 9)The Health and Safety (Display Screen Equipment) Regulations 1992 set legal standards for thosewho use computers for a significant part of their normal daily routine. However, the standardsthey specify are good practice whether you use the computer for half and hour a day or sevenhours a day.The Trust recognises and fully accepts its duties and responsibilities and will ensure that:• A suitable and sufficient risk assessment of each workstation used by a ‘user’ is carriedout and reviewed annually.• Any identified risks to employees are reduced as far as is reasonably practicable.This guidance applies to all ‘users’ and their workstations but the standards set should also beapplied to workstations not used by ‘users’ where possible.Page 15 of 70

Document Reference Code RM/006/09The workstation should be risk assessed in conjunction with the ‘user’ concerned. Just adjustingthe chair or monitor or re-arranging the desk can make the workstation a safer place to work. All‘users’ should be trained to ensure they are aware of the hazards and what they can do to improvetheir workstation. Eye tests are available from Occupational Health.Please use form as in appendix 9 and see the Trust Health and Safety Policy for furtherinformation.Risk Assessment of Chemicals: Control of Substances Hazardous to Health (COSHH)(appendix 10)Complying with the COSHH Regulations is an ongoing process and every new, potentially harmful,substance must be assessed before it is used in the workplace.Having gathered a list of substances used in the work area, an assessment of the risks to healthmust be made. The substances where the risks are trivial do not have to be recorded e.g., use ofair freshener in an officeWhere a basic assessment is not required, a product date sheet for the substance must be held inthe department for reference in an emergency.For the majority of substances used within the Trust, a basic assessment will be sufficient but forthose considered high risk or where product date sheets are not available e.g., biological agents, anon standard assessment will need to be completed in conjunction with the basis assessment.For further information see the Trust Health and Safety PolicyWork EquipmentTo ensure that equipment standards are met a risk assessment must be carried out. This mustconsider the equipment, where it is being used and by whom. It should establish the actionneeded to meet the legal requirements and prevent accidents.For further information see the Trust Health and Safety Policy and Medical Devices PolicyManual Handling Risk Assessment (appendix 11)The Manual Handling regulations require the Trust to assess any manual handling operations thatmay be hazardous and to take the necessary steps to prevent injuries.Please complete form as in appendix 11.For further information see the Trust Health and Safety Policy/Manual Handling PolicyLone WorkingBoth the Health and Safety at Work etc Act 1974 (HASAWA) And the MHSWR 1999 place dutieson Managers/Supervisors to identify the hazards arising from working alone and ensure there areadequate controls in place to minimise any risks.Actions required to ensure reduced risk to lone workers should form part of theWard/Department/Directorate local working polices and ideally be documented and disseminatedto all staff that are affected.Page 16 of 70

Document Reference Code RM/006/09Please complete form as in appendix 12For staff at risk of violence and abuse in the workplace, please also refer to the Policy TherapeuticManagement of Violence and AggressionFalls/Environmental Assessments (appendices 13 - 16)An annual assessment should be made of the environment in which you work for areas caring forpatients at high risk of falling, a specific falls environment assessment should be carried out.Where hazards are identified, these should be addressed in the manner described in section 7.9 SummaryAccountabilityProcess• Overall responsibility for managing risk lies with the Chief Executive.• That responsibility is devolved down through the management structure to theNetworks through the Executive Director of Delivery, Improvement/Executive Nurse.• On a day-to-day basis the Network/Service Manager/Modern Matron are responsiblefor ensuring that a rolling programme of clinical and non-clinical Risk Assessments arecarried out, recorded and monitored.• Where control measures are required to reduce, or eliminate risks, the Network/ServiceManager/Modern Matron should ensure that appropriate action is taken.• Where identified risks are considered to be unacceptable, these should be entered ontothe Directorate/Corporate Risk Register as appropriate.All Wards and Department are required to carry out risk assessments within their area.• Each area should have representatives of all grades and disciplines to consider theactivities within the area being assessed and identify the potential hazards that existeither by process mapping or ‘thought shower’.• To prioritise the assessment process commence risk assessments on identified riskthat fall within the red and blue areas of the Matrix.• Identify who is at risk.• Identify any specific Risk Assessments that will be required to comply with legislation(see section 8).• Each identified risk will be graded for its consequence and likelihood using the 5 x 5Risk Scoring Matrix (appendix 2).• Record the control measures already in place and any measures that are required tofurther reduce or eliminate the risk• The Risk Assessment Record (appendix 1) and any supporting documentation shouldthen be escalated through the Network Management process to agree an action plan,any resources required and for ratification through the Directorate programme.• The Network/Service Manager/Modern Matron is responsible for ensuring that all staffare informed of the risks within their areas and the control measures put in place.Whilst there is corporate responsibility, each individual also has a responsibility in law toidentify risk and take steps to control it.Page 17 of 70

Appendix 1 – Risk Assessment RecordDocument Reference Code RM/006/09Speciality: Ward / Dept:Brief description of physical location covered:Hazard, Problem or Concern:(Something which has the potential to cause harm/damage)Risks(What has/will cause the hazard to be realised and what could the impact be if realised)Please identify one of the Corporate objectives which will be affected by the risk identified:Control Measures already in Place:(What is already in place to prevent the hazard being realised)Objective 1 – Achieve excellent service ratings from clients and regulatorsObjective 2 – Include clients, carers and members in service designObjective 3 – Develop our workforce to meet service needsObjective 4 – To achieve best value and generate a surplus to invest in our servicesObjective 5 – Diversify and develop services to increase income or meet needsObjective 6 – Provide services from high quality facilitiesObjective 7 – Promote green working and reduce travel, carbon and wasteObjective 8 – Work with our partners in our communities to create life opportunitiesAre the control measures in place adequate?YES/NORisk Evaluation: (Please use the 5x5 scoring matrix to assess consequence, likelihood andPriority)Consequence 1 2 3 4 5 Likelihood 1 2 3 4 5 Priority L M H CPlease circlePeople affected Patients Staff Visitors Contractors OthersName, Designation of person completing the risk assessment:Name:Designation:Date:Page 18 of 70

Document Reference Code RM/006/09Without further control measures in place, is the identified risk:Acceptable?Unacceptable?What alternative options are there that could be considered to reduce the risk?What is the preferred option to reduce this risk?Section 2 (to be processed through local network process for managing risk)Action Required By Whom Time Scale forcompletionCompletedResources Required: (Please include cost and recurring costs)If the above actions are taken, is the residual risk acceptable? YES/NOPlease recalculate the risk score with the recommended control measures taken into considerationConsequence 1 2 3 4 5 Likelihood 1 2 3 4 5 Priority L M H CPleasecircleThis Assessment’sPlease give detailsrecommended actions andpriorities are agreed/declined Position:Signature:Date:Who owns the risk identified?Please give detailsName:Position:At what level has this risk beenentered onto the Risk Register?Please give detailsDate for ReviewA copy of This Risk Assessment Record, Should be held locally and accessible to staff.A copy should be forward to the Risk Management Dept for the central library.Advice on Risk Assessment may be obtained from the Risk Management dept Ex 1019Page 19 of 70

Appendix 2 – Risk Scoring MatrixDocument Reference Code RM/006/09Table 1 Consequence Scores (C)Choose the most appropriate domain for the identified risk from left hand side of the table, thenwork along the columns in the same row to assess the severity of the risk on the scale of 1-5 todetermining the consequence score, which is the number given at the top of the column.Consequence score (severity levels) and examples of descriptors1 2 3 4 5Domains Negligible Minor Moderate Major CatastrophicImpact on the safety ofpatients, staff or public(physical/psychologicalharm)Quality/complaints/auditMinimal injuryrequiringno/minimalintervention ortreatmentNo time off workPeripheralelementtreatmentservicesuboptimaloforInformalcomplaint/inquiryMinor injury orillness, requiringminorintervention.Requiring timeoff work for 14 daysIncrease in length ofhospital stay by >15daysMismanagement ofpatient care with longtermeffectsNon-compliance withnational standards withsignificant risk topatients if unresolvedMultiplecomplaints/independentreviewLow performance ratingCritical reportIncident leading todeathMultiple permanentinjuriesorirreversible healtheffectsAn event whichimpacts on a largenumber of patients.Totallyunacceptable levelor quality oftreatment/serviceGross failure ofpatient safety iffindings not actedonInquest/ombudsmaninquiryGross failure tomeet nationalstandardsHuman Resources/Organisationaldevelopment/staffing /competenceStatutory duty /inspectionsShort-term lowstaffing level thattemporarilyreduces servicequality (1day)Low staff moralPoor staffattendance formandatory/keytrainingSingle breech ofstatutory dutyUncertain delivery ofkey objectives/servicedue to lack of staffUnsafe staffing level orcompetence (>5 days)Loss of key staffVery low staff moraleNo staff attendingmandatory / keytrainingEnforcement actionMultiple breeches inNon-delivery of keyobjective/servicedue to lack of staffOngoing unsafestaffing levels orcompetenceLoss of several keystaffNo staff attendingmandatory training/key training on anongoing basisMultiple breeches instatutory dutyPage 20 of 70

statutory dutyReducedperformanceratingunresolvedifChallengingexternalrecommendations/ improvementnoticeDocument Reference Code RM/006/09statutory dutyImprovement noticesLow performance ratingCritical reportProsecutionComplete systemschange requiredZeroratingperformanceAdverse publicity /reputationBusiness objectives /projectsFinanceclaimsincludingRumoursPotential forpublic concernInsignificant costincrease /scheduleslippageLocal mediacoverage –short -termreduction inpublicconfidenceElements ofpublicexpectation nobeing met£10,000-£50,000 overproject budgetScheduleslippage< £10,000 £10,000-£50,000Local mediacoverage – longtermreduction inpublic confidence£50,000-£250,000 overproject budgetScheduleslippage£50,000-£250,000National mediacoverage with 3days service wellbelow reasonablepublic expectation.MP concerned(questions in theHouse)Total loss of publicconfidenceIncident leading>£500,000 overproject budgetSchedule slippageSchedule slippageKey objectives notKey objectives not met met£250,000-£500,000 >£500,000Service / businessinterruptionLoss/interruptionof >1 hourLoss/interruptionof >8 hoursLoss/interruptionof >1dayLoss/interruption of >1weekPermanent loss ofservice or facilityEnvironmental impactMinimal or noimpact on theenvironmentMinor impact onenvironmentModerate impacton environmentMajor impact onenvironmentCatastrophic impacton environmentTable 2 Likelihood score (L)What is the likelihood of the consequence occurring?The frequency-based score is appropriate in most circumstances and is easier to identify. It shouldbe used whenever it is possible to identify a frequency.Likelihood 1 2 3 4 5ScoreDescriptor Rare Unlikely Possible Likely Almost CertainFrequency This will Do not expect it Might happen Will probably Willprobably never to happen/recur or recur happen/recur undoubtedlyHow Often happen/recur but it is possible occasionally but it is not a happen/recurmight it/does ithappenit may do sopersisting issue possiblyfrequentlyPage 21 of 70

Table 3 Risk Scoring = Consequence x Likelihood (C x L)Document Reference Code RM/006/09LikelihoodConsequence 1 2 3 4 5Rare Unlikely Possible Likely AlmostCertain5 Catastrophic 5 10 15 20 254 Major 4 8 12 16 203 Moderate 3 6 9 12 152 Minor 2 4 6 8 101 Negligible 1 2 3 4 5For grading risk, the scores obtained from the risk matrix are assigned grades as follows:Instructions for use1 – 3 Low risk4 – 6 Moderate risk8 – 12 High risk15 – 25 Extreme risk1. Define the risk(s) explicitly in terms of the adverse consequence(s) that might arisefrom the risk.2. Use table 1 to determine the consequence score(s) (C) for the potential adverseoutcome(s) relevant to the risk being evaluated.3. Use table 2 (above) to determine the likelihood score(s) (L) for those adverseoutcomes. If possible, score the likelihood by assigning a predicted frequency ofoccurrence of the adverse outcome. If this is not possible, assign a probability to theadverse outcome occurring within a given time frame, such as the lifetime of a projector a patient care episode. If it is not possible to determine a numerical probability thenuse the probability descriptions to determine the most appropriate score.4. Calculate the risk score the risk multiplying the consequence by the likelihood:C (consequence) x L (likelihood) = R (risk score)5. Identify the level at which the risk will be managed within Cornwall Partnership NHSFoundation Trust, assign priorities for remedial action, and determine whether risks areto be accepted on the basis of the colour bandings and risk ratings, and CornwallPartnership NHS Foundation Trust’s risk management system. Include the risk onCornwall Partnership NHS Foundation Trust’s risk register at the appropriate level.Page 22 of 70

Appendix 3 – Risk RegisterDocument Reference Code RM/006/09NumberDateenteredon RiskRegisterDescription andsource of the of riskSeverityLikelihoodRiskRateScoreDate lastmodifiedOwnerMitigatingaction and theircostProgress onmitigatingactionResidualscoreR A GPage 23 of 70

Appendix 4 – Steps in doing a Risk Assessment FlowchartDocument reference code: RM/006/09Step 1Identify the hazardsStep 2Decide who might beharmed and howStep 3Evaluate the risk anddecide on precautionsStep 4Record your findingand implement themStep 5Review yourassessment andupdate as necessaryPage 24 of 70

Appendix 5 – Risk Register ProcessDocument reference code: RM/006/09Ward/Office and Team Level

Corporate Risk Register > 15Document reference code: RM/006/09New Directorate Risk RegisterLearning DisabilitiesRisk RegisterAdult Mental HealthRisk RegisterDrug & Alcohol TeamRisk RegisterChildren’s ServicesRisk RegisterFinanceRisk RegisterCHESSRisk RegisterBodmin Inpatient Unit(Less than 10)Longreach Inpatient Unit(Less than 10)North CMHT(Less than 10)West CMHT(Less than 10)Mid CMHT(Less than 10)Older Persons(Less than 10)Page 26 of 70

Appendix 6 – Examples/Hazards and Risks, Associated RiskDocument reference code: RM/006/09HazardSlip/Trip/FallsFalls from height/falling objectsCollision with objectsManual HandlingElectricityContact with chemicalsLone WorkingExamples/Hazards and Risks, Associated RisksFall of a person on the same levelFall of a person, object/materialBumps and BruisingBack, injuries, cuts, injury to jointsFire, shock, burnsDermatitis, burns, poisoningNo support/back up in situations which may arise e.g.,violence and aggression service userPage 27 of 70

Document reference code: RM/006/09Appendix 7a – Risk Assessment Checklist for ‘New and Expectant Mothers’GUIDANCE ON COMPLETING THIS FORMThis form is designed to determine the risks associated with pregnancy while at work, it appliesequally to a New, an expectant mother (unborn child) and the risks associated with new motherswho are breastfeeding on return to work.This form is designed to be used with all four stages of the risk assessment process. An initial riskassessment (Stage 1) should have been carried out in the workplace. This looks at the risks to allwomen of childbearing age and the results conveyed to all employees. This is a generic styleassessment, if this has not been done it should be completed before a stage risk assessment iscarried out.This form is also to be completed by the Manager of the expectant mother, upon notification thatthe employee is pregnant. (Stage 2 risk assessment) The hazards identified are to be noted onthis form and an action plan completed with the risk ratings is to be written up. The manager is toagree the action plan, its implementation and review dates with the employee at this assessment.The assessment is to be reviewed throughout the pregnancy, (Stage 3 risk assessment)because as the pregnancy develops new hazards are likely to develop as the expectant mother’shealth, shape and mobility changes.After the pregnancy and upon return to work a further review is to be carried out, (stage 4 riskassessment) this is most important if the new mother is breastfeeding.Please tick the appropriate boxes adding further information in the comment box.Boxes ticked ‘No’ may highlight concerns indicating a risk assessment and action arenecessary.Please contact the Risk & Safety Services Department Ext 2908 if you require furtherguidancePage 30 of 70

Document reference code: RM/006/09HospitalDirectorateForenamesJob TitleDETAILS OF THE EXPECTANT, NEW OR BREASTFEEDING MOTHERPlace of Work(ward/dept/area)Work Tele No.SurnameSignatureDetails of the Assessor(s), the assessment dates and reviewsInitial Risk Assessment(stage 1) (date checklistand action plan firstcompleted)Specific Risk Assessmentupon notification ofpregnancy (stage 2)Review Assessmentduring pregnancy (stage3)Assessment on return towork (stage 4)Forename Surname Signature Job Title DateChecklist 11. Physical HazardsDetermine if the employee is exposed to any of the hazards listed below, tick theappropriate box and then elaborate in the comments box where you have answered ‘YES’to paint a word picturea) Is the employee exposed to(constant or excessive) heatabove ambient temperatures?CommentsInitialassessmentStage 1Assessments duringpregnancy Stages2 and 3Assessmenton return towork Stage 4Yes No Yes No Yes No Yes Nob) Is the employee exposed to(constant or excessive) coldbelow ambient temperatures?CommentsYes No Yes No Yes No Yes Noc) Is the employee exposed tonoise, either constant orexcessive in the normal courseof their work?Yes No Yes No Yes No Yes NoPage 31 of 70

CommentsDocument reference code: RM/006/09d) Is the employee exposed toexcessive dust in the normalcourse of their work as a resultof a work process?CommentsYes No Yes No Yes No Yes Noe) Is the employee exposed toshock or vibration (particularlywhole body low frequency) inthe normal course of their work?(NB:- this in particular applies tothose who drive on a regularbasis as part of their job)?CommentsYes No Yes No Yes No Yes Nof) Does the employee have to adoptany awkward postures or carry outany excessive movements that maycause physical and/or mentalfatigue in the normal course of theirwork? (NB:- pregnancy causes anincrease in girth that makes itsometimes awkward to adopt acomfortable position, retain balanceetc.)CommentsYes No Yes No Yes No Yes Nog) Is the employee exposed (orlikely to be exposed) to ionizingor non-ionising radiation in thenormal course of their work?CommentsYes No Yes No Yes No Yes Noh) Does the employee or is theemployee expected to carry outmanual handling tasks duringthe normal course of their work?CommentsYes No Yes No Yes No Yes Noi) Does the employee carry outany work where they areexposed to Hyperbaricatmospheres?CommentsYes No Yes No Yes No Yes NoPage 32 of 70

Checklist 2Document reference code: RM/006/092. Chemical HazardsDetermine if the employee is exposed to any of the hazards listed below, tick theappropriate box and then elaborate in the comments box where you have answered ‘YES’to paint a work picture. Guidance – Check your COSHH assessments, and/or hazard datasheets and/or check the labels on all containers/packaging.a) Is the employee exposed inthe normal course of their workto any of the followingchemicals:-• Mercury,• Lead• Carbon MonoxideCommentsInitialassessmentStage 1Assessments duringpregnancy Stages2 and 3Assessmenton return towork Stage 4Yes No Yes No Yes No Yes Nob) Is the employee exposed inthe normal course of their workto any substance absorbedthrough the skin?CommentsYes No Yes No Yes No Yes Noc) Is the employee exposed to oruses, handles, administersCytotoxic (Antimitotic) Drugs inthe normal course of their workCommentsYes No Yes No Yes No Yes Nod) Is the employee in the normalcourse of their work to anysubstance labelled oncontainers/packaging asfollows:-• R40 possible of irreversibleeffects• R45 may cause cancer• R46 may cause heritablegeneric damage• R61 may cause harm to theunborn child• R63 possible risk of harm tothe unborn child• R64 may cause harm tobreast fed babiesCommentsYes No Yes No Yes No Yes NoPage 33 of 70

Document reference code: RM/006/09e) Is the employee exposed inthe normal course of their workto any substance labelled onthe containers/packaging asTeratogenic or MutagenicCommentsYes No Yes No Yes No Yes Nof) Is the employee exposed toany fumes or vapors which arecreated or caused as part of awork processCommentsYes No Yes No Yes No Yes Nog) Does the employee work withany anesthetic gases Yes No Yes No Yes No Yes NoCommentsh) Is the employee exposed toany other than substancecovered by the COSHHregulationsCommentsYes No Yes No Yes No Yes NoChecklist 33. Biological HazardsDetermine if the employee is exposed to any of the hazards listed below, tick in theappropriate box and then elaborate in the comments box where you have answered ‘YES’to paint a word picture. GUIDANCE:-a) Is the employee exposed inthe normal course of their workto any of the following, morethan they would be outside ofwork?• HumanCytomegalovirus(especially in children’sward)• Hepatitis B• Humanimmunodeficiency virus(HIV)• Listeria (especially foodworkers)• Human parovirusYes No Yes No Yes No Yes NoPage 34 of 70

• Rubella (GermanMeasles)• Varicella-zoster(Chickenpox)• Tuberculosis• HerpesCommentsDocument reference code: RM/006/09b) Is the employee exposed toany other bacteria or viruses inthe normal course of theirwork, more than they would beoutside of workList and CommentsYes No Yes No Yes No Yes Noc) Is the employee suffering fromany form of skin infectionCommentsYes No Yes No Yes No Yes NoChecklist 44. Hazards relating to working conditions and ergonomicsDetermine if the employee encounters any of the hazards listed below, tick in theappropriate box and then elaborate in the comments box where you have answered ‘YES’to paint a word picture. GUIDANCE: -Consider the employees increasing size includingcomfort and balance.a) Does the employee work with oruse Visual Display Units (VDU’s)on a daily basis or as a significantpart of their job?CommentsYes No Yes No Yes No Yes Nob) Does the employee work inconfined or small areas or dothey visit patient’s homes, whichimpede movement due to theincreased size of the expectantmother?CommentsYes No Yes No Yes No Yes Noc) Does the employees PersonalProtective Equipment (PPE) ifpreviously issued still fit correctlyYes No Yes No Yes No Yes NoPage 35 of 70

and give the same degree ofprotection it? (NB:- Uniformshould also be considered)CommentsDocument reference code: RM/006/09d) Is the employee exposed tonauseating smells, which mayaffect them in pregnancy?CommentsYes No Yes No Yes No Yes Noe) Does the job entail long periodsof standing/adverse posture orinvolve a job where Dexterity,agility, co-ordination, speed ofmovement or reach may beimpaired because of increasingsize?CommentsYes No Yes No Yes No Yes Nof) Does the job entail visiting orattending patients whose home orworkplace presents hazards notnormally encountered in ahealthcare premise? If “yes”please list.CommentsYes No Yes No Yes No Yes Nog) Does the job entail visiting orattending patients outside of thehealthcare environment who maybe presupposed to violentbehavior?CommentsYes No Yes No Yes No Yes Noh) Given that hazards exist in theworkplace or are inherent in a job:are their any additional or unusualhazards that exist or are createdsolely due to a women’spregnancy and/or size? i.e.-Balance, access or vision.CommentsYesNo Yes No Yes No Yes NoPage 36 of 70

Checklist 5Document reference code: RM/006/095. Free formatPlease add further identified hazards and specific comments as necessaryHazard IdentifiedComments/ActionGeneral CommentsPage 37 of 70

Document reference code: RM/006/09Appendix 8 – Young Persons Risk AssessmentManagers Overall Health And Safety ChecklistMANAGERS YES NO REMARKS/COMMENTSHas a person/department been nominated to be theoverall contact for young workers, including those onwork experienceWhere students are on a work experience placement,has effective liaison been established with theplacement organisers, including arrangements forregular monitoring and reporting of incidents/nearmisses/ill healthHave ‘suitable and sufficient’ risk assessments beencarried out prior to the student joiningHave any additional control measures for youngpeople clearly been identifiedHave risk assessments taken into account of anyspecial health and safety needs which young workersmay have as a result, for example, of any physicaland learning disabilities, or health issues such asallergies, asthma and respiratory problems, heartdisease, diabetes, colour blindness, deafness or theuse of prescription medicinesHave work activities which young people should beprohibited from undertaking been clearly identifiedHave necessary steps been taken to isolate or makesafe dangerous tools, plant equipment or substancesHave any necessary arrangements for personalsafety and freedom from sexual harassment, violenceand aggression or bullying been consideredHave parents or guardians been informed of risksand control measuresHave arrangements been made for appropriatesupervision and training, including induction beenmadeHave work tasks for young people been properlydefined and explained? Do young people understandwhat is required of them in order to protect their ownsafety and health and that of othersHave young workers been provided with appropriateinformation about hazards, risk and precautionsCompleted by nameDatedSignature of ManagerNB:This form should be filed with the risk assessment and checklists so as to present acomplete record for that individual.A copy of this form is to be forwarded to the Risk Management DepartmentPage 38 of 70

Document reference code: RM/006/09Appendix 8a – Managers/Student Combined Plan Of Work Record Form And Checklist ForYoung PersonsInstructions for use:This checklist is to be shared with individual students by the Manager and sets out what theManager expects from the student, it is to be completed before the student joins and again after aperiod of days/weeks after the student joins the Trust as an employee or for work experience. It isto be signed by both Manager and student and is to be kept on file.Name of Young PersonPlace of Work(Ward/Dept/Area)Length of placement From ToDate of BirthSiteStatus (delete as applicable)Employee / Work experienceName of ManagerAs a Manager, you have a particular responsibility for the young people who work for you. Alwaysremember that they are more vulnerable than experienced members of staff, in particular, early on,you need to discuss with them the following items.Date of Risk AssessmentBrief Job DescriptionSpecific RestrictionsProhibition of the use of specific equipmentProhibition of specified processes etcActivities only to be undertaken with supervisionRestricted areasDone(enter date)To be completed by Manager(enter the specific issues that relate to thisindividual)Contact ArrangementsRoutine contactsIn case of problemsName and role of MentorName of Safety RepresentativePage 39 of 70

Document reference code: RM/006/09Emergency evacuation procedure Done To be completed byManagerLocation of fire exitsLocation of fire extinguishers and break glasspointsAction of discovering a fireInform student of testing regimeAction on hearing fire alarmEmphasise do not use a lift in the event of a fireEmphasise that it is dangerous to block fire doorsand fire exitsFirst Aid and Incident/Near Miss Reporting Done To be completed byManagerWhat to do in the event that you need First AidHow to call an AmbulanceHow to report an Incident/Accident/Near MissJob SafetyHazards and Precautionsa) Chemical substances including body fluidsHazardspresent in jobSafety overviewgiven to studentSpecificadditionaltrainingrequiredb) Noisec) Extremes of temperature (heat/cold)d) Electricale) Lifting and Handlingf) Machinery and Equipmentg) Display Screen Equipmenth) Housekeepingi) Site Transportj) Exposure to potentially violent oraggressive people including patientsk) Other (please state)Page 40 of 70

Document reference code: RM/006/09Hazard Reporting, unsafe acts and conditions Done To be completed by ManagerJob Specific Hazards(please specify)DoneTo be completed by ManagerDSE Users Done To be completed by ManagerRisks and Precautions outlinedTraining Done To be completed by ManagerAdditional training required not specifiedMiscellaneous Done To be completed by ManagerConfidentially disclosureCash and ValuablesPersonal Gifts or RewardsPersonal Possessions, SecurityIdentificationA copy of this form is to be forwarded to the Risk Management DepartmentPage 41 of 70

Tasks to be completed/workplace, dates and activitiesDocument reference code: RM/006/09Plan of Work(set by the Manager)Timescale Student Activities DateCompletedI confirm that the checklist and plan of work form have been completed, that the student has seenthe form and checklist, agrees and understands itSignedStudentSignedManagerDatedNB:This form should be filed with the risk assessment and checklists so as to present acomplete record for that individual.Page 42 of 70

Document reference code: RM/006/09Appendix 8b – Example guidelines for Risk Assessments for Managers of Young PersonsInstructions for use:This guideline document is designed to assist Managers when they carry out their RiskAssessments on young people and work experience students, to highlight areas that they shouldincluded in their General Risk Assessments and the main risks that will be encountered. It is notcomprehensive as individual areas will have slightly different risks dependant on where the studentis working, however it seeks to inform Managers and students of a set of common risks throughoutthat can be used in completing the document shown in Appendix 2 and the actual Combined RiskAssessment and Action Plan form at Appendix 5Ref Young Persons Task StatementNo.1.1 Students must not set, reset or in any wayinterfere with any medical devices unless underthe direct supervision of a Registered Nurse1.1 Students must not carry out jobs that involveworking at heights1.2 Students must not participate in or observe anyemergency resuscitation procedures1.2 Students must not participate in, or assist withthe moving or physical supporting of patients1.3 Students should at all times work under thesupervision of a trained/qualified member of staffwho is competent in the task being undertaken3.2 When handling patients, universal precautionsshould be taken i.e. gloves and aprons to beworn4.1 Students must be briefed and ensure that theyknow the location of emergency escape routesand fire exits4.2 Students must be briefed and ensue that theyknow the location of fire extinguishers and breakglass points4.3 Students must be informed on the action to betaken on discovering a fire6.1a Students if handling body fluids must takeuniversal precautions and wear gloves andaprons5.1 Students must be informed of the first aidfacilities in their designated place of workMain RisksAccidental start-up of machinery, injuryto hands from moving machinery parts,inappropriate adjustments giving rise tomalfunction and injuryFalls, slips from stools and ladders etcresulting in injuryPersonal distress, TraumaPhysical injury to student and PatientLack of knowledge/experience leadingto unsolicited errors resulting in injury topatients and themselvesInfection Control and personalprotection against chemicals and otherhazardous substancesIncreased risks to patients, visitors andstaff in escaping from fire, injury,damage to property, litigation andmedia coverageIncreased risk of fire spread and injuryto patients, visitors and staff, damage topropertyIncreased risk of fire spread and injuryto patients, visitors and staff, damage topropertyInfection controlNot knowing who their First Aiders orAppointed persons are, not knowing theLocation of First Aid Kits, injuryRisks remain undiscovered leading to5.3 Students must be informed of how to report anincident in accordance with Trust policyinjury, Litigation8.1 Students must attend all safety related Lack of knowledge leading tomandatory trainingunsolicited errors8.1 Students must attend Induction training Lack of knowledge, unsolicited errors9.1 Students must be informed not to disclose Release of confidential medicalconfidential patient related information, gained as information, Litigation, media interestPage 43 of 70

a result of their placement to anyone other thanthose within the immediate care team9.2 Students must ensure that due care is taken ofpatients belongings and that the presence ofcash and valuables is brought to the attention ofa member of Cornwall Partnership NHSFoundation Trust staff9.3 Students must not accept any personal gifts orrewards of any kind from patients or their visitors.Any such offers must be reported to the person incharge9.4 Students must ensure that their personalpossessions are secured9.5 Students must ensure that they are issued withidentificationDocument reference code: RM/006/09Complaints, Media attentionPosition compromised, complaints,litigation and media attentionTheft, Position Compromised,complaints, litigation and mediaattentionSecurity breachPage 44 of 70

Document reference code: RM/006/09Appendix 8c – Example guidelines for Risk Assessments for Managers of Catering Staff,Young PersonsRef Young Persons Task StatementNo.1.1 Students must not set, reset or in any wayinterfere with any machinery unless under thedirect supervision of a qualified member of staff1.1 Students must not carry out jobs that involveworking at heights1.1 Students must not use/clean food slicers, mixers,food processors or Potato chippers1.1 Students must not use any form of WasteCompactors1.1 Students must not be given the task of using,cleaning or draining (deep) fat fryers1.2 Students must not participate in or assist with themoving or physical supporting of Heavy loads1.2 Students must not be given the task of De-boningmeat1.3 Students should at all times work under thesupervision of a trained/qualified member of staffwho is competent in the task being undertaken3.1 Students must be made aware of the need towear protective equipment when handling food3.2 Students must be made aware of what types ofprotective equipment they need to wear for thevarious tasks they will be engaged in4.1 Students must be briefed and ensure that theyknow the location of emergency escape routesand fire exits4.2 Students must be briefed and ensue that theyknow the location of fire extinguishers and breakglass points4.3 Students must be informed on the action to betaken on discovering a fire5.1 Students must be informed of the First Aidfacilities in their designated place of work5.3 Students must be informed of how to report anincident in accordance with Trust policy6.1 Students must know if it part of their jobexpectations how to use the dishwasher6.1 Students must know if it part of their jobexpectations how to clean floorsMain RisksAccidental start-up of machinery, injuryto hands from moving machinery parts,inappropriate adjustments giving rise tomalfunction and injuryFalls, slips from stools and ladders etcresulting in injuryAccidental start-up of machinery, injuryto hands from moving machinery partsInjury from contact with movingmachinery, entrapmentFire, burns, spillages, inappropriatewaste disposalPhysical injury from manual handlingSevere cut or stab wounds from knivesLack of knowledge/experience leadingto unsolicited errors resulting in injury topatients and themselvesFood contaminationInfection Control and personalprotection against chemicals and otherhazardous substancesIncreased risks to patients, visitors andstaff in escaping from fire, injury,damage to property, litigation andmedia coverageIncreased risk of fire spread and injuryto patients, visitors and staff, damage topropertyNot knowing what to do, possible injuryor loss of lifeNot knowing who their First Aiders orAppointed persons are, not knowing theLocation of First Aid Kits, use of blueplastersRisks remain undiscovered leading toinjury, LitigationManual Handling, Use of cleaningmaterials, slips, trips and falls oncrowded or wet floorsManual Handling, Use of cleaningmaterials, slips, trips and falls from wetfloors and seepages/spillagesPage 45 of 70

Document reference code: RM/006/096.1 Students must know the correct procedures fordisposing of refuse and other rubbish6.3 Students must know the correct procedures forthe handling and use of corrosive cleaningmaterials, including oven cleaners if this is part oftheir job6.3 Students who assist in preparing hot food mustbe aware of the handling risks involved6.3 Students who assist in preparing and servingfood must be made aware of the correct practicefor using tools and serving food8.1 Students must attend all safety relatedmandatory training9.2 Students must ensure that due care is taken ofcash handling and other valuables entrusted totheir care and control and any discrepancy isbrought to the attention of a member of CornwallPartnership NHS Foundation Trust staff9.3 Students must not accept any personal gifts orrewards of any kind from patients or visitors. Anysuch offers must be reported to the person incharge9.4 Students must ensure that their personalpossessions are secured9.5 Students must ensure that they are issued withidentificationCorrect types of colour-coded bagsused in hospitals- wrongly disposed ofwaste, manual handling, cuts frombroken glassChemical burns to skin or eyesBurns, scolds, slips, trips and falls,Manual Handling, SpillagesCuts from sharp knives, slips, trips andfalls, Manual Handling, SpillagesLack of knowledge leading tounsolicited errorsComplaints, Media attentionPosition Compromised, complaints,litigation and media attentionTheft, Position Compromised,complaints, litigation and mediaattentionSecurity breachPage 46 of 70

Document reference code: RM/006/09Appendix 8d – Young Persons combined Risk Assessment and Action Plan formHospital Ward/dept Assessors Name AssessmentDateGroup Tel No Signature Review DateACTIVITIESRISK ASSESSMENT SUMMARYACTION PLANSNAME OF LEAD OR RESPONSIBLE PERSONSDept SerialNo. RiskRegister NoHAZARD ORCONCERNPlease describeRISK OR HARMPlease add descriptionand include details ofthe Number of personsaffectedState details ofexisting controlsin place tomitigate riskCurrentNumericscoresLik.Sev.StateTotalCurrentRiskScoreUsing5x5MatrixACTIONS TO BEIMPLEMENTEDState details of additionalactions/controls requiredto eliminate/reduce riskTargetDeadlineforactionand/orcontrolsin placeResidualNumericscoresLik.Sev.State TotalResidual RiskScore Once theActions And/OrAdditionalControls Are In PlaceDate ActualDeadline thataction and/orcontrols arein placeNB:Please ensure that you use the same checklist with this Risk Assessment form, otherwise you will not be able to check back on the risksidentified. Also, please continue on a separate sheet if appropriate.Page 47 of 70

Appendix 9 – Display Screen Equipment Initial ChecklistDocument reference code: RM/006/09GUIDANCE NOTESThis form is designed to assist in an initial display screen equipment checklist being undertaken toidentify hazards and risks when working in a computer related environment.Please tick the appropriate box. Following which further risk assessment and action may benecessary.Please contact the Risk Management Department Ext 1019 if you require further guidance.Directorate Dept/Office Contact Ext:Name of User: JobTitle: ChecklistDate:1. THE SCREENa. Is the screen image stable and flicker free Yes NoCommentsb. Does the screen have a brightness/contrast control Yes NoCommentsc. Does the screen have a tilt and swivel base Yes NoCommentsd. Is the screen free from reflection and glare Yes NoCommentse. Have you been provided with a filter screen Yes NoComments2. THE KEYBOARDa. Is it possible to easily alter the angle of the tilt of the keyboard Yes NoCommentsb. Is there adequate space at the front of the keyboard to provide support forthe hands and wristsCommentsYesNoc. Are the characters on the keys easily readable Yes NoCommentsd. Can you find a comfortable keying position Yes NoCommentsPage 48 of 70

Document reference code: RM/006/093. OTHER EQUIPMENTa. Has a document holder been provided Yes NoCommentsb. Have you been provided with a mouse-mat Yes NoCommentsc. Have you been provided with a wrist-rest Yes NoComments4. THE ENVIRONMENT - Space, Lighting, Reflection & Glare, Noise, Temperature, Humiditya. Is there enough space, with storage, to enable easy access to theYes NoworkstationCommentsb. Is there adequate lighting for all tasks Yes NoCommentsc. Are desks lamps supplied where necessary Yes NoCommentsd. Are blinds or curtains fitted at windows Yes NoCommentse. If so, do they prevent reflection and glare Yes NoCommentsf. Is noise considered a problem in the workplace Yes NoCommentsg. If yes, has the noise source been resited or moved away from theworkstationCommentsYesNoh. Is the temperature maintained at a level which ensures user comfort Yes NoCommentsi. Have sources of excess heat been suitably controlled or eliminated. Yes NoComments5. FURNITUREPage 49 of 70

Document reference code: RM/006/09a. Is the desk or work surface sufficiently large enough to accommodate Yes Nocomputer, keyboard printer and other necessary work equipmentCommentsb. Is there enough space under the work surface to enable the user toachieve a comfortable position and move legs freelyCommentsYesNoc. Is the worksurface free of glare and reflection Yes NoCommentsd. Does the chair have 5 castors Yes NoCommentse. Does the seat have adjustable height, backrest and tilt facility Yes NoCommentsf. Are you able to adjust the chair comfortably Yes NoCommentsg. With chair adjusted are your feet flat on the floor Yes NoComments6. OPERATOR COMPUTER INTERFACEa. Is the computer software user friendly Yes NoComments7. JOB DESIGNa. Does the job allow for work activities away from the computer screen Yes NoCommentsb. Are you encouraged to take short frequent breaks away from the screen Yes NoCommentsc. Does your computer work involve work of a repetitive nature with thekeyboardCommentsYesNod. Does your computer work involve work of a repetitive nature with themouseCommentsYesNoPage 50 of 70

Document reference code: RM/006/098. INFORMATION & TRAININGe. Have you received information and/or documentation relating to safeuse of working with display screen equipmentCommentsYesNof. Are you aware of the Trust arrangements for vision screening via theOccupational Health DeptCommentsYesNog. Have you received training on possible hazards of working with displayscreen equipmentCommentsYesNoh. Have you received training on how to adjust the position of display screenequipment and the workstationCommentsYesNoi. Are you encouraged to take short frequent breaks away from the screen Yes NoCommentsj. Do you think training on working with display screen equipment would bebeneficialCommentsYesNoDSE Checklist carried out by (please print)DesignationDept/OfficeDateContact Tel: ExtPage 51 of 70

Document reference code: RM/006/09Appendix 10 – Control of Substances Hazardous to Health Regulations 2004 (COSHH) Inventory and Summary List of COSHH AssessmentsDirectorate:- Assessors:- Assessment Date:- Actual Site(Ward/department./specific area):-Location:-Review date:-ItemNo.Substance Quantity Freq. OfUseDuration ofExposurePersonsExposedHazardsto HealthOverallRiskRankingNumerical riskrankingL,M,H,E Impact LikelihoodPage 52 of 70

Appendix 11 – Manual Handling Practical Assessment FormDocument Reference code: RM/006/09Name:Trainer:Ward/Dept:Designation:Manager:Technique1 Lifting/handling inanimate objects2 Assisting people to stand with:• transfer belt• turntable3 • Correct use of electric beds.• Bed rails.4 Assisting people to move in bed:• turning with slide sheet• sitting forward• moving up/down with:• slide sheet• Removing of slide sheet.5 Transfer bed to chair and backusing passive hoist.Safely getting a fallen patient upfrom the floor.6 Use of passive hoist with:• standard sling• de luxe sling• access sling• long seat sling• Disposable sling7 Use of standing hoist with:• Standing sling Deluxe• Transport sling8 Wheelchairs9 Techniques relevant to work baseTheoryOnly(please tick)CorrectlyDemonstrated(please tick)Y N N/AElements requiringDevelopmentCOMMENTSCompetence has been demonstrated in the above techniques as indicated.Trainer Signature:Date:Candidate Signature:Date:NB: The candidate was competent at the time of the assessment. It is the Manager’s responsibilityto ensure workplace compliance and the candidate’s responsibility to adhere to their training.Staff member to have six monthly competence assessment in regard to equipment used.53 of 70

Document Reference code: RM/006/09Appendix 11a – Manual Handling Practical Assessment Form: Inanimate Load & PhysicalInterventionName:Ward/Dept:Trainer:Designation:Manager:Technique1 High RiskMovement use of physicalintervention2 BoxSquatHalf squatOne kneeUsing chair/stool etc3 Trolley4 Chair wheelchair5 Orange / laundry Bag6 Sack/bin sack7 Team lifting8 OtherBathingWalking (supported)Household choresTheory Only(please tick)CorrectlyDemonstrated(please tick)Y N N/AElements requiringDevelopmentCOMMENTSCompetence has been demonstrated in the above techniques as indicated.Trainer Signature:Date:Candidate Signature:Date:NB:The candidate was competent at the time of the assessment. It is the Manager’sresponsibility to ensure workplace compliance and the candidate’s responsibility toadhere to their training.54 of 70

Document Reference code: RM/006/09Appendix 11b – Manual Handling Guidance for Completing a Generic / Individual RiskAssessmentGUIDANCE NOTES - This form is designed to assist in identifying manual handling hazards andthe associated risks in your workplaceCHECKLISTTHE TASKS - THIS INCLUDES LIFTING / TRANSFERING / MANOUVERINGDo they involve:a. Holding loads away from trunk?b. Twisting / stooping?c. Reaching upwards?d. Long carrying distance?e. Strenuous pushing or pulling?f. Unpredictable movement of loads?g. Repetitive handling?h. Insufficient rest or recovery period?I. A rate of work over which you have no controlTHE LOADS - INANIMATE / ANIMATE:a. Heavy?b. Bulky / unwieldy?c. Difficult to grasp e.g. wet / slippery?d. Unstable / unpredictable?e. Harmful e.g. sharp edges / hot to touch?THE WORKING ENVIRONMENT - are there:a. Contraints on posture?b. Is the flooring in poor condition?c. Variations in floor levels?d. Hot, cold or humid conditions?e. Poor lighting conditions?f. Ergonomics (is space adequate / limited)?g. Is there appropriate equipment for use?55 of 70

Appendix 11c – Client/Patient Manual Handling Assessment FormDocument Reference code: RM/006/09CLIENT NAME: …………………………..B NUMBER: ………………………….DATE: ……………………………….Is the patient/client independently ambulant? Yes NoIf yes please sign and place in the assessment section of notes.Complete this form if needs of patient/ client changeIs the patient/client non ambulant?If yes please complete the following form and add to the assessment section of notes.Is the patient/client Bariatric? Yes NoIf yes please complete the following form and add to the assessment section of notes.Section ABed Mobility score Sitting Balance scoreIndependent 0 Independent 0Independent withequipment1 Supervision only 2Supervision only 2 Help+1 with equipment 4Supervision withequipment3 Help+1 no equipment 5Help+1 with equipment 4 Help+2 or more withequipmentHelp+1 no equipment 5 Help+2 or more noequipment68Help+2 or more withequip.6 Unable to assist 10Help+2 or more no equip. 8Unable to assist 9Transfers score Walking scoreIndependent 0 Independent 0Independent withequipment1 Independent withequipment1Supervision only 2 Supervision only 2Supervision withequipment3 Supervision withequipment3Help+1 with equipment 4 Help+1 with equipment 4Help+1 no equipment 5 Help+1 no equipment 556 of 70

Document Reference code: RM/006/09Help+2 or more withequip.6 Help+2 or more withequip6Help+2 or more no equip. 8 Help+2 or more no equip 8Unable to assist 10 Unable to assist 10Score range Risk level Colour0 – 5 = Low risk Green6 – 34 = Medium risk Amber35 and above=High riskRedReport for section ADates score colour Designation SignatureComplete client /patient handling Action planComplex handling issues should be discussed with Physio’s and/or OT’s Manual handlingAdvisor as appropriateSection BTo be completed if any of the following would cause a problem when being supported withmoving and handling.Psychological score Special Risks ScoreCommunication difficulties 5 Major surgery 10Unpredictable 10 Sedated/drowsy 10Challenging physicalbehaviour5 History of falls 1010 Pain restricting movement 10Bariatric / Difficult to handlepatients10Report for section BScore range Risk level Colour0 – 5 = Low risk Green6 – 34 = Medium risk Amber35 and above=High riskRed57 of 70

Dates score colour Designation SignatureDocument Reference code: RM/006/09BARIATRIC CLIENT/PATIENT MANUAL HANDLING ACTION PLANHEIGHTDocument the following – Handling method, equipment andNumber of staff required for safest practice.BODY MASS BODY TYPE CIRCUMFRENCE OF THE WAISTINDEXDATEHANDLINGACTIVITYEQUIPMENT Handlingbelt/slidingsheets/boards. Zimmerframe etc.,Bed ManoeuvresSIZE (SLING) S, M,LBariatricNo. OF STAFFREQ’DChair to Bed/Bed toChairTurn over in bedSit up from lyingMove back up bedDaily ActivitiesSittingSit to standFrom chairWalkingBathing (In & out ofbath)DressingSpecial requirements specific to areaTransport58 of 70

Document Reference code: RM/006/09EquipmentNamesignaturePhysiotherapyreferral.Occupationaltherapy referral.Manual HandlingAdvisorSIGNATUREDATE59 of 70

Document Reference code: RM/006/09Appendix 11d – Manual Handling6 MONTHLY PRACTICAL ASSESSMENT OF COMPETENCE ON EQUIPMENT SPECIFIC TOPRACTICENameBaseDate of AssessmentEquipment Used Date Staff Signature AuthorisationReview DateStaff SignatureAuthorisationManual HandlingTrainer’s SignatureNBOne completed this form must be brought to Compulsory Practical update60 of 70

Document Reference code: RM/006/09Appendix 12 – Lone Workers pre Risk Assessment Checklist: Working alone in buildingsStaff exposed to the risk i.e. group & numberWard/ DepartmentSiteChecklist completed byDate completedReview DateMain Issues of concern Yes NoDo staff work alone?Do staff work outside normal office hours?Do staff meet with clients or patients in isolated locations?Is there enough security provision?Is there poor access to the building?Do staff activities involve working in confined spaces?Do staff activities involve handling dangerous substances?Control measures for consideration Yes NoDo you provide joint working for high risk activities?(i.e.: in confined space and with dangerous substances)Do you use entrance security systems?( i.e.: digital locks or swipe cards)Is there a security lighting around access points and parking areas?Have you installed panic buttons linked to manned locations?Do you use reporting check- in systems?Do you use two-way radios or other communication systems?Do staff have information and training on basic personal safety?Are staff trained in strategies for preventing and managing violence?Do staff have access to form for reporting incidents or near misses andappreciate the need for this procedure?Are your existing control measures adequate?If NO what modifications or additional actions are necessary?12345NOTE:If you have identified a risk associated with this work activity please completethe Trust Risk assessment Form.61 of 70

Appendix 12a – Lone Workers Checklist: Domiciliary visitsStaff exposed to the risk i.e. group & numberWard/ DepartmentSiteChecklist completed byDate completedReview DateDocument Reference code: RM/006/09Main Issues of concern Yes NoDo staff carry out visits in high-risk locations (i.e. areas with high crime rates)?Do staff carry out visits in isolated rural area?Do staff visit unfamiliar clients or relatives?Do staff visit a high-risk or unstable or unpredictable client group?Do staff carry out visits during unsocial hours?Do staff carry valuables or drugs?Control measures for consideration Yes NoDo you provide accompanied visits when there are concerns about safety?Do you include potential or known risk factors in referral documents and careplans?Do you share risk information with other professional and agencies?Are there systems for monitoring staff whereabouts and movements for regularlyreporting to base?Have you issued mobile phones?Have you issued personal attack alarms?Do staff have information and training on basic personal safety?Are staff trained in strategies for preventing and managing violence?Do staff carry forms for reporting incidents or near misses andappreciate the need for this procedure?Are your existing control measures adequate?If NO what modifications or additional actions are necessary?12345Note: If you have identified a risk associated with this work activity please complete theTrusts Risk Assessment Form.62 of 70

Document Reference code: RM/006/09Appendix 12b – T.M.A.V. Training Needs AssessmentIs the member of staff in contact withService Users, Relatives or GeneralPublic?NOTMVA Training need is ConflictResolution TrainingYESIs the member of staff working on aninpatient unit in Mental Health orTreatment unit in Learning Disabilities?NOTMVA Training need is PersonalSafety CourseIs the member of staff part of thenursing team?NOTMVA Training need is PersonalSafety Course (appropriate restraintcourse is optional with Managersagreement)Training need isPhysical InterventionsEldercareOlder Person (MH)What type of unit dothey work on?LDTMVA Training need isPersonal Safety andPhysical InterventionsAdultTMVA Training need is Personal Safetyand Teamwork Restraint course63 of 70

Document Reference code: RM/006/09Appendix 13 – Initial Falls Assessment5 QUESTION SCREENING TOOL/OVERVIEW FALLS SCREENING TOOLPatients Full Name:Patients DOB:Ward:CR Number1. Is there a history of any fall in the last 12 months? (Include this fall) YES/NO*Number of falls in the last 12 months……………..2. Is the person on four or more medications per day? YES/NO*Number of medications per day…………………….3. Does the person have a diagnosis of stroke or Parkinson’s disease? YES/NO4. Does the person report any problems with their balance? YES/NO5. Is the person unable to rise from a chair of knee height without using YES/NOtheir arms?Date &Time of Last Fall:Full Name of AssessorAssessor Base:Assessor Signature:Job Title:Department/Ward:DateIf the patient scores three or more ‘YES’ answers a multi-factorial risk assessment must becompleted.64 of 70

Document Reference code: RM/006/09Appendix 14 – Multi factorial Falls Risk AssessmentMULTIFACTORIAL FALLS RISK ASSESSMENT TOOLPatientNameCRDOB1. History of Falling - history of one or more falls in past year? Yes/NoPrompts: Ask history of falls, frequency, context and characteristicsFall Indoor or outdoors?History of dizziness, L.O.CHistory of recurrent fallsACTION: Refer to Falls Service2. Number of Medications - takes >4 medications per day? Yes/NoPrompt: Identify type of medication being prescribed.Including eye drops.ACTION: Needs Medication review3. Central Nervous System Suppressants - use of 1 or more for more than twoweeks?Yes/NoPrompts: Identify type of medication being prescribed i.e. hypnotics,antidepressants, sleeping pills and antipsychoticsACTION: Needs Medication Review4. Alcohol Intake - >1 unit alcohol per day Yes/NoPrompts: Advise regarding immediate and long term fall risk due to dulling of neurologicalcapacity from alcoholACTION: Refer For Advice to GP or Practice Nurse5. Postural Hypotension present i.e. 20mmHg drop on lying to standing ordizziness on standing/sitting up?Yes/NoPrompts: Teach to prepare for movement by simple lower limb muscle contractions and toStabilise self after changing position and before walkingACTION: Needs medical review6. Vision - difficulty in reading, cannot recognise an object across the room,recently started wearing bifocals?Yes/NoPrompts: Raise awareness regarding risks due to blurring and difficulty in judging distance65 of 70

Advise disuse of bifocals or care when first wearing themAdvise to concentrate on walking and be deliberate/ cautious,especially in new situations and on uneven surfacesACTION: Needs eye testDocument Reference code: RM/006/097. Hearing – has difficulty hearing conversational speech? Yes/NoPrompts: Teach family about visual cueingUse of amplifiers, earphones and hearing loops.ACTION: Needs hearing examination8. Walking/Gait – is unsteady on feet, shuffles or takes uneven steps/ishousebound?Yes/NoPrompts: Check walking aid and observe gaitCheck feet and footwearTimed Get Up and Go >15secACTION: Needs Physiotherapy assessmentNeeds foot care and footwear advice9. Functional ability – Reports decreased function and confidence? Yes/NoPrompts: Observe transfers and functional activitiesSit to stand >3 secs?Identify problem activitiesFear of falling?ACTION: Needs therapy assessment10. Balance – needs to hold onto furniture, requires stick or frame? Yes/NoPrompts: Can patient stand unsupported for 30 secs?Patient reports feeling unsteady / dizzy?ACTION: Needs physiotherapy assessment11. Environmental Hazards on the ward – untidy, slip/trip hazards? Yes/NoPrompts: Is bed space uncluttered? Does patient require low bed?Check chair height/ sitting balance. Consider bed rails.Is call bell within easy reach?ACTION: Maintain clear environment & access to call bell. Considerspecialist equipment. Consider moving to easily observable area.12. Lower urinary tract (LUT) - has difficulty getting to the toilet in time? Yes/NoPrompts: Has overwhelming urgency to void?Gets wet before reaching the toilet?66 of 70

Document Reference code: RM/006/09Needs to go frequently by day?Is woken up from sleep with desire to void?ACTION: Needs continence assessment and advice leaflet13. Mental state – Has memory problems or low mood? Yes/NoPrompts: History of forgetfulness, confusion or loss of confidence?Poor concentration?ACTION: Needs 6 CIT Dementia assessmentNeeds 4 item Geriatric Depression Scale14. Osteoporosis Risk? Yes/NoPrevious low trauma fracture?Corticosteroid use? > 7.5mg prednisolone for 6 months or moreFamily history of osteoporosis? – especially maternal hip fractureHeight loss or Kyphosis?Low body weight? BMI

Document Reference code: RM/006/09Appendix 15 – Protocol for the use of the Multi factorial Falls Risk Assessment ToolFor use by Health and Social Care professionals for all patients / clients who score 2 or more onthe 5 question screening tool1. History of fallingAccurate history of fall and circumstances will help inform decision to refer to falls service:Loss of Consciousness, recurrent or unexplained falls, history of facial injury or dizzinessassociated with change of position indicates need for medical review in Falls Clinic.Consider type of dizziness: Light headed = CardiovascularUnsteady = CerebrovascularVertigo = ? VestibularInformation available: ‘Staying Steady’ Help the Aged2. Number of medicationsNote potential discrepancy between medication prescribed and compliance by patient.Culprit medications for falls include diuretics, antihypertensives and CNS suppressants.Information available: ‘Managing your Medicines’ Help the Aged3. Central Nervous System SuppressantsCheck dosage and time of day it is taken4. Alcohol intakeBe mindful of patients self assessment of alcohol units consumed5. Postural HypotensionPatient procedure:1. Lie patient down for 15 minutes2. Stand patient up – take 2 nd reading3. Maintain standing for 3 minutes – take 3 rd readingNote symptoms such as light headedness6. VisionOver 60’s are eligible for a free eye test every 2 years at opticiansInformation available: ‘Better Sight’ Help the Aged7. HearingNote viral or ear infections may cause vestibular symptoms.Information available: ‘Better Hearing’ Help the Aged8. Walking / GaitObserve for discontinuous steps, difference in step length, deviation from path or shuffling68 of 70

Document Reference code: RM/006/09Timed get up and go Test (TGUG) components:1 Getting up from chair2 Walking 3 metres3 Turning4 Walking 3 metres (return)5 Sitting downIdentify foot care routine, note abnormalities of skin and nails. Look for general flexibility offoot and ankle. Foot wear checks – note size, whether supportive and safe fit.Information available: ‘Keeping Mobile’ and ‘Fitter Feet’ Help the Aged9. Functional AbilityNote potential difference between perceived and actual functional ability.Sit to stand taking more than 3 seconds indicates lower limb dysfunction.Use 0-10 scale to record self assessment of fear of falling 0 = no confidence10 = usual for you10. BalanceTimed unsupported steady stand (TUSS) of less than 30 seconds indicates balanceproblems and impaired postural stability.11. Environmental HazardsSmall modifications of the environment such as provision of rails and removal of tripshazards / loose mats can reduce risk of falls. Encourage self assessment of theenvironment and activities to consider potential risk.Information available: ‘Safety in your Home’ Help the Aged12. Lower Urinary Tract Infection (LUTI)Urgency - overwhelming urge to voidFrequency - voiding more than 8 times per dayNocturia - woken from sleep more than twice per weekSee ‘ Management of frail and older person with Urinary Incontinence’ CornwallContinence Promotion ServiceInformation available: ‘Bladder and Bowel Weakness’ Help the Aged13. Mental StateCognitive Impairment Test (6 CIT) (straightforward questions that can be conversationalrather than feel like a test). The higher the score the more impairment is indicated.Geriatric Depression Scale (4GDS)See ‘Shared Care Pathway for People with Dementia’ Appendix 4 pages 36 and 37Cornwall Partnership NHS Foundation Trust – Older Peoples Mental Health ServicePublic Internet Site14. Osteoporosis RiskReinforce links between bone health and falls and fracture risk.Information available:‘Healthy Bones’ and ‘Healthy Eating’ Help the AgedNational Osteoporosis Society’ www.nos.org.uk69 of 70

Appendix 16 – Minimising the Risk of Falls – Environmental AssessmentDocument Reference code: RM/006/09Ward/Dept:Name of Assessor:Date of Assessment:Job title:AssessmentAre bed heights at the correct height for eachpatient?Are chair heights the correct height for patients?Is there effective lighting?Are call bells within patient reach?Are patient belongings within easy reach?Has action been taken to maximise observation ofall patients? E.g. position of nurse baseAre patient bed areas free from clutter/equipmentwhich may form obstacles?Are bed brakes on?Is the pathway from bed to toilet free fromobstaclesAre bathrooms/toilets clearly labelled?Is the floor safe and dry?Have patients got appropriate footwear?How long does it take for a call bell to beanswered? (No. of minutes)Yes, No,N/AAction taken/Comments70 of 70