Risk Assessment Policy

Document Control Details Keith Reynolds Document Lead: Risk Support Services Manager Joint Health and Safety Forum Ratified By: Joint Risk Management Forum 4 Document Version Number: Implementation Date: Review Date: August 2004 August 2007 (Latest)

Risk Assessment Policy Table of Contents Page Risk Assessment Policy

Introduction Scope Responsibility Communication of Assessments Policy Review 3 3 3 4 4

Risk Assessment Guidance

Why assess risks? Definitions Risk Assessment and Risk Register Process Diagram Who should conduct general risk assessments?

5 5-6 7 8-9

General Risk Assessment Process

Risk Identification Risk Assessment Appendix A Preliminary Risk Assessment Form (RMPA01) Appendix B Moving and Handling Checklist (RMSRA01) Appendix C Self Harm Checklist (RMSRA02) Appendix D Hot Surfaces Checklist (RMSRA03) Appendix E Physical Security Checklist (RMSRA04) Appendix F Workplace Checklist (RMSRA05) Appendix G Lone Working Checklist (RMSRA06) Appendix H Computer Assessment (RMSRA07) Appendix I Clinical Risk Checklist (RMSRA08) Appendix J Violence and Aggression Checklist (RMSRA 09) Appendix K New and Expectant Mothers at Work (RMSRA10) Appendix L Chemicals Checklist (RMSRA11) ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------10 11 - 18 19 20 21 22 23 24 25 26 27 30 31 32 33 34 35 36

Risk Assessment Policy 1. Introduction The Trust recognises the business and legal reasons for conducting risk assessment. For this reason this policy, with accompanying guidance, sets out its approach to risk assessment. It describes the process, which will be followed including documentation, which will be used and individual responsibilities of staff. It also describes how this process will interface with other clinical risk assessment processes. It is important that staff are involved in the management of risk and reference is made to how staff representatives will be included in the assessment process. Finally, the document describes how risks, which cannot be managed at a local level, will be communicated to the level of management who can either accept the risk on behalf of the Trust or who will take action to reduce the risk. At all times staff and their accredited representatives are kept informed of the current status of the risk. 2. Scope This policy and guidance will apply to all Trust activities, but will be particularly helpful in assessing local risks within services, wards or departments. Assessments will take into account risks created by the Trust, which could affect any person, and in some circumstances property including data. The term 'person' will include staff, patients, relatives, members of the public, volunteers, contractors and anyone else who may be affected by the Trust activities. Special attention will paid where staff working for different organisations work closely together for example, contracted domestic workers in a ward environment, employees working in buildings occupied by employees of another organisation. 3. Responsibilities The Chief Executive has overall responsibility for risk assessment within the Trust and for ensuring that effective arrangements are in place to manage identified risks. Each Director has responsibility for risk assessment within their areas of responsibility and for ensuring that the appropriate level of resources and commitment are employed in this process. Each Director will monitor their managers in ensuring that appropriate resources are put into place to ensure assessment of their service is conducted. Directors are responsible for monitoring the results of risk assessments and have a part to play in allocating resources to manage the risks, which cannot be managed locally. 3

Each Director will report to the Trust Board, actions taken to address risk assessment, together with their proposed action plans. Every Trust Manager is responsible for the assessments carried out in their area. They will ensure that arrangements are made to: Train sufficient numbers of local assessors for their area, or attend the training themselves, if they chose to carry out their own assessment Allow sufficient time for assessors to conduct adequate assessment Consult involve with staff and their safety representatives during the assessment process Endorse assessments, with or without alteration Agree local action plans to remove or reduce risks identified during the assessment Refer risks to the appropriate senior manager or committee where they cannot be managed locally Make temporary adjustments and keep staff and their representatives informed of progress in managing risks that cannot be fully managed locally Review assessments if there is reason to suspect that it is no longer valid or there has been a significant change. Identify any member of staff, who is considered to be especially at risk.

Employees' have a duty to cooperate with their managers and local risk assessors when they are conducting risk assessments. They are also responsible for cooperating with their managers in implementing any remedial action to reduce the risk. Failure to cooperate is a serious matter as this can place the employee and possibly others at risk. The Trust has arranged for local risk assessors and managers to have competent advice in the risk assessment process from Anglia Support Partnership's Risk Support Services. Directors and Managers will use this resource as appropriate. 4. Communication of Assessments All managers will maintain records of risk assessments which will be brought to the attention of all employees and contractors who may be affected by the risks, and the measures they need to take to avoid the risk before they work in the area. 5. Review of the Policy This policy will be reviewed no later than once every three years or early if required.

Risk Assessment Guidance Document Why do we need to assess risks? We face and deal with risks everyday, most of the time we assess and manage risks without making a formal written assessment. At work we are able to manage the risk ourselves without having to refer to others in the organisation. However, there are some risks, which are beyond our ability to fully understand or control. These risks need formal risk assessment after which some can be controlled and managed by the individual or local team, however others may need to be referred to more senior staff in the organisation who will decide how to manage the risk. Definitions The following definitions are used to assist those involved in risk assessment: Hazard - A hazard is something, which has the potential to cause injury, illness or harm, for example: 1. Cytotoxic drugs are hazardous substances, as they can cause burns to the skin and injure the lungs if inhaled 2. Sharps, such as syringes, have the potential to transmit infection if they puncture the skin after being injected into another person Risk - Risk is the likelihood that a hazard will have an adverse outcome with a consideration of how bad the outcome is likely to be. An example is: 1. A sharps disposal bin left on the floor in a clinic presents a high risk of injury, especially to inquisitive children. 2. Sharps correctly placed in bins which are out of reach, normally pose a low risk of injury to children. Risk Assessment - Risk assessment is a careful examination of what, in your work practice and area, could cause harm so that you can weigh up whether you have taken enough precautions or should do more. Risk assessment of individuals - Assessments of individual patients are carried out by clinical staff and include assessments for moving and handling, pressure sores, mental health (e.g. Care Programme Approach). Although based on the same principles, this document does not refer to how these assessments are conducted. However, these are important assessments normally recorded in the clinical notes which must be up to date and available for all staff who need to know. This will sometimes include non-clinical staff such as porters and social carers where information such as safe handling techniques or information about aggressive behaviour will be as relevant to them as it is to clinical staff.

General Risk Assessment General risk assessments are assessments of specific processes or areas rather than an individual person. This document refers to how these assessments are conducted. It is just as important that these assessments are kept up to date and made available to everyone who needs to know about them. However, review periods will normally be longer than individual assessments, which are reviewed sometimes on a daily basis. The term 'general risk assessment' may be misleading as perhaps it implies that one assessment considers all risks in an area, whereas in fact there are probably many general risk assessments. The term 'general' refers to the nature of the assessment being in a wider context than just one individual patient. A general assessment can be made of the risks of violence and aggression in a department or area, and the means for reducing the risk. A general moving and handling risk assessment will consider the normal working environment and the types of handling risks posed to staff. An individual risk assessment will relate to how a specific patient's mobility needs will be managed. Although the two are linked, they are quite different processes. The diagram below outlines the risk assessment process.

Preliminary risk assessment

Further risk assessments required? Yes Risk assessment checklist

No

RISK ASSESSMENT AND RISK REGISTER PROCESS v3.1 Aug 2004

Reassess no later than 2 years.

Risks identified? Yes General risk assessment and action plan discussed with local manager

No

Can risks be managed locally?

No

Refer to line manager/senior clinician

Can risk be managed?

No

Can the residual risk be accepted by this person?

No

Local risk management/ clinical governance committee

Yes Can risk be accepted or managed by local RM committee? Yes Report decision/ action to local staff and return risk assessment documentation to local assessor No

Yes Yes

Trust risk management/ clinical governance committee

Yes

Can risk be managed/ accepted by Trust RM committee?

No Trust Risk register

Implement risk action plan Trust Board

Who should conduct General Risk Assessment? Lead Clinicians and Ward/Department Managers must determine locally how risk assessments will be managed: What activities/tasks will be assessed? Who will undertake the assessments (see training below) What will happen with the assessment when it is completed What action will be taken when needs are highlighted by the assessment If recommended control measures are beyond the finances of the ward, department or service, what interim measures can be taken to make the task or environment safer Agree local action to control the risk while resources are sought from higher levels of the organisation How best to share the outcomes of the risk assessment with all staff and others who may be affected by the risk Communication with staff on progress in managing risks How to involve staff and their representatives in assessing the risk How frequently risks should be re-assessed Where necessary action is beyond the control of the assessing department, they must be raised with the line manager. However, this does not prevent the local team from taking appropriate temporary action to manage the risk in the interim

Local Risk Assessors Local risk assessors may be assigned by ward/department managers to assist them in carrying out risk assessment. This does not remove the managers' legal responsibility for carrying out assessments. Local assessors are responsible for: Agreeing with their manager which general risk assessments will be carried out in the department and the way in which they should be conducted (see below) Attending risk assessment training, including update and refresher sessions (see training below) Conducting risk assessments on behalf of the ward/department manager Communicating the findings of assessments to staff and their representatives when requested by their manager Keeping copies of assessments available locally Informing managers when assessments need reviewing

All Staff All Staff have a responsibility for managing those risks, which they can and should manage. Acting within their level of competence all staff will manage a situation as it arises. Only as it develops beyond their ability to deal with it will they need to refer to their line managers or lead clinician. However, it is always good practice to keep managers and lead clinicians informed of developing situations. When they are managing a risk they should communicate the risk and action taken to those who may be affected by it. For example, staff may identify risks from moving and handling a patient and the appropriate way to manage the patient safely. They must ensure that this information is communicated to anyone else who will care for the patient to ensure consistency of care and safety of members of the team and the patient or service user. Everyone has a responsibility to share information about risk as part of a risk assessment. This can include: Identifying a risk and informing their manager that they believe a formal risk assessment is necessary Sharing information during formal assessments to establish the level of risk (e.g. how frequently a risk arises, and the potential or actual outcomes) Making suggestions to managers on how risks could be reduced Keeping themselves informed of local risk assessments by reviewing the risk assessment file held locally Acting in accordance with the findings of an assessment

Service Managers/Leads Service Managers and Service Leads are responsible for ensuring that local managers conduct risk assessments. This should be monitored as part of the annual appraisal. When head clinicians or ward/department managers have highlighted a risk because they believe it is outside their control, Service Managers/Lead are responsible for deciding how the risk will be managed. Some options include: Accepting the risk where they are permitted to do so (refer to Table 3) Authorising or requesting that the local manager or lead take action Service manager or lead refers the matter to a more senior manager Refer the matter to the appropriate committee including the Risk Management Committee, Health and Safety Committee, Clinical Governance Committee with a full description of the risk and a risk treatment option appraisal Await further advice or information before taking action. An example may be that further risk advice is needed from ASP Risk Support Services, Infection Control or Human Resources

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

Risk Management/Clinical Governance Committees If local Risk Management or Clinical Governance Committees exist in the Trust they have the same responsibilities with regard to risk assessment as the Trust-wide Risk Management/Clinical Governance Committees, except they do not report to the Trust Board and they only make decisions for the area they represent. Trust-wide Risk Management/Clinical Governance committees are responsible for management of the Trust Risk Register and monitoring progress of risk treatment plans. Where Service Managers/Leads are unable to manage a risk due to lack of resources or the risk is otherwise outside their control, it will be discussed at the risk Management/Clinical Governance Committee. The committee will consider the assessment against other priorities on the risk register and the Trust objectives. A decision will be made and the risk will be entered into the risk register. Decisions including action plans and any subsequent changes to the plan will be communicated to the originating local ward or department via minutes of the committee. Ward and departments are responsible for communicating any changes related to a risk on the register to the Trust Risk Management/Clinical Governance committee.

General Risk Assessment Process

1. Risk Identification Before an assessment can be carried out, risks in the department must be identified. The chart below describes some of the assessment types, which may be used depending on the context of the area or procedure being assessed. Identification Method Context Department/Physical Area Procedure/Process Equipment 9
Inspection Nominal group technique Incident reports Maintenance records

9 9 9

9 9 9 9 9

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

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Nominal group technique involves a group of people identifying what they feel to be the highest risks within the context of the assessment. The group starts by defining the nature of the area or process being assessed then either brain storms or 'brain writing1[1]'. Inspections can be conducted by an individual, or as a group. Groups can consist of local staff, accredited Trades Union Safety representatives or may include peers who work in another area. They can also include risk specialists such as infection control advisors, safety specialists, occupational health advisors or Estates staff according to the complexity of the assessment, the time available and the availability of the specialists. Incident review will identify the frequency of certain types of incident as well as the severity of any outcome. Despite this being a reactive rather than proactive method of risk identification, it is still a useful tool. Complaint and claim information should also be used to identify trends. Maintenance record review will identify issues related to facilities and equipment. Frequent repairs of equipment may indicate that either the wrong type of equipment is being used, or that that staff do not know how to use it. Frequent repairs to the building may identify a hazard such as vandalism or potential for fire. There are other methods of risk identification if these methods are insufficient, further advice is available from ASP Risk Support Services. 2. Risk Assessment

Risk assessment is a careful examination of the identified hazards to determine whether and how they could cause injury loss or damage to people or property, whether enough precautions are in place or whether more should be done. Once hazards have been identified, the remaining components of the risk assessment are: Who or what might be harmed and how How likely it is that an incident would arise from the hazard How severe would an incident be if one related to the hazard occurred Judgement of whether the risk is adequately controlled

Risk assessment can be carried out by an individual, or alternatively by a group as described in the hazard identification stage. When risks are being assessed, consideration should be given to: All the relevant situations which arise including days, evenings, nights and weekends.

Brain writing is a very similar technique to brain storming. Brain storming involves the participants calling out hazards which are then written on a flipchart. Brain writing requires participants to write their thoughts on 'Post-it' notes which are gathered together, themed and presented to the participants. The advantage of brain writing is that the conversation does not become weighted towards those members who may normally exert most influence.

1[1]

11

Situations which occur less frequently such as some clinical procedures, maintenance of areas or equipment, adjustment of medical equipment etc. Unplanned events such as spillages Emergency situations such as sudden changes in a patient condition Situations which arise due to changes in weather

Preliminary Risk Assessment A preliminary risk assessment should be conducted first. This allows the individual assessor or group to determine which risks are so low that they need no further consideration. It is not expected that an assessment will be conducted on every single risk that could arise in the area or process. What is important is that the main risks are identified and measures put in place to manage them. A preliminary risk assessment is a way of using the information gathered so far to decide which risks will require further assessment. Form RMPA001 (Appendix A) should be used to record the general findings. All participants should be recorded on the assessment form. The manager as the responsible person should sign the form to acknowledge that they accept the initial assessment as valid. If they do not agree with any part of the assessment they should inform the assessor and make alterations. Managers are legally responsible for these assessments and consequently for any error or inaccuracy made on them. The assessor should consider each part of the assessment form and decide whether a further more detailed assessment is required. For example, if an assessment was being conducted in a community dentist service, then a detailed risk assessment would not be necessary for bathing, but one would be required for safe moving and handling if patients often have reduced mobility. In this example, ticks would be placed under the staff column of the moving and handling row. Only identified risks ticked on the form will be taken to the next stage, and a formal risk assessment carried out. Risk Assessment checklists A number of checklists have been developed relating to specific themes. These are included in the following appendices Appendix B Moving and handling checklist - Ref RMSRA01 Appendix C Self harm - Ref RMSRA02 Appendix D Hot surfaces checklist - Ref RMSRA03 Appendix E Physical security checklist - Ref RMSRA04 Appendix F Workplace checklist - Ref RMSRA05 Appendix G Lone working checklist - Ref RMSRA06 Appendix H Computer checklist - Ref RMSRA07 Appendix I Clinical risk checklist - Ref RMSRA08 12

Appendix J Violence and aggression - Ref RMSRA09 Appendix K New & expectant mothers at work risk assessment - Ref RMSRA10 Appendix L Chemical checklist - Ref RMSRA11 Can we see the forms? These forms should be used to record the significant findings of the assessments. The relevant risk assessment form can be completed by an individual or by a group. The purpose of the form is to lead the assessor to think about sources of risk related to a specific theme such as moving and handling or violence. For example, the environmental risk assessment form will ask the assessor to look at a variety of physical conditions such as floors, lighting or temperature which may lead staff, patients or visitors to be at risk. Where any risk is identified as being inadequately controlled, an estimate of the risk rating must be made on the General Risk Assessment form. General Risk Assessment form Risks on the focussed form which are considered to be inadequately controlled are transferred to the General Risk Assessment form Ref RMGRA01 (appendix L). These forms are used to assess the risk rating by asking the assessor to state the likelihood of the risk occurring and the severity if it does arise. The assessor starts by recording their details and the date of the assessment. Description of Activity A brief description of the area or activity being assessed. Significant hazards Transfer the findings from the Focussed risk assessment to this section. Adverse effects and people at risk Include the likely adverse effects if an incident were to occur related to this hazard. Although the form states 'People at risk' it can include property including data, or others. Number of people affected This can be difficult to judge, for example six people in an office is straightforward compared with hundreds of people approaching a receptionist every day. The best way to record this is to put it in the context of a timeframe. The assessor should remain consistent with this time frame when assessing likelihood later down the form.

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What precautions exist to control the risk Either record what is already in place to control the risk, or alternatively what can be put in place immediately. Risk rate Assess the risk rate by reference to the likelihood and severity charts. What measures are required? Indicate the type of action necessary to further reduce the risk. This will be transferred to the risk action plan. Actions need to be realistic and achievable. If a risk cannot be managed locally, reasons should be recorded in this section. Re-evaluated rate Reassess the risk on the basis that the recommended action is implemented. Sign off The person responsible for the action and the accountable manager must be recorded on the assessment form. Risks are assessed by comparing the risk severity and likelihood scores against the tables below: Table 1: Risk Likelihood Scores
RATE 0 1 2 3 4 5 LIKELIHOOD Impossible Rare Unlikely Moderate Likely Certain DESCRIPTION Could not occur This risk is not expected to recur in our lifetime, e.g. the hazard posed at the start of year 2000 This descriptor covers those risks that are infrequently occurring However it remains a possibility e.g. the re-emergence of some of the viruses thought to have been previously eradicated Risk may re-occur occasionally. You may consider issues that occur once or twice a year or less frequently than this Risk will probably re-occur but is not a persistent issue. There are no issues of custom and practice but we know from our experiences that the risk does present itself from time to time Risk is frequently occurring. Issues that are a constant threat, or issues that are identified as custom and practice, would fall under this descriptor

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Description

0 Negligible

A Potential impact on individual(s)/ family members, visitor, contractor, staff member No real risk of harm (physical or psychological)

B Potential impact on organisation + resource implications *** No real increase in risk exposure No real risk of damage No real risk of public concern / complaint Negligible financial loss < 500 Minor increase in risk exposure Minor risk of damage Minor risk of public concern / complaint Minor financial loss < 5K (think increased bed days, think theft, think damaged equipment, think compensation) Some risk of property damage (broken chairs, windows, room closure) Some loss of user/patient confidence, small risk of User Complaint Minor financial loss <10k (think increased bed days, think additional treatment required, think theft, think damaged equipment, think compensation) MDA Reportable, Mental Health Act Commission Assessment, Loss employee work time >3 days < 20 days Loss of service user confidence, Probable complaint +/- adverse publicity Significant property damage (e.g. requiring ward/service closure) Moderate financial loss >10K - <250K Health & Safety Exec Investigation, Inspection by CHAI Public Inquiry, Serious complaint anticipated, Loss employee work time >20 days Breach of legislation or other formal Regulation Public outrage, Loss of Public Confidence Temporary Service closure Removal of royal college training status Major financial loss >250K - <500k Criminel prosecution Extended service closure; Loss of essential service and contingency failure Regularity intervention (e.g. HSE, CHAI ) Permanent Removal of service National adverse publicity Critical financial loss >500K

C Number of persons affected at one time N/A

1 Minor

Minor risk of harm (physical or psychological)

N/A

2 Moderate

Risk of temporary injury or illness physical or psychological (e.g. staff sickness of less than 3 days, injury that will resolve within a month)

1-2

3 Serious

Semi Permanent injury or illness & injury physical or psychological (i.e. long recovery tail but full recovery anticipated)

4 Major

Permanent (i.e. life long) Injury

Small numbers 3-15 (e.g. Control and Restraint, management of Challenging Behaviour, Violent incident in A&E. Toxic gas emissions, poor standards of hygiene & D&V out break) Moderate numbers 1650 e.g. Lost specimens Hostage situation D&V outbreak with ward closure Many >50 e.g. Vaccination error; Screening errors / failure to recall

5 Critical

Unexpected avoidable death(s) Suicide/ Homicide

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Table 2: Risk Severity Scores Where a risk falls into more than one category of severity, the highest score must be used. So for example if a risk would result in permanent injury (4 Major), Regulatory authority intervention (Critical 4) and affect moderate numbers of people (moderate 3), the highest score of 4 will be used. From the severity and likelihood rates a risk rating can be established and should be recorded on the assessment form. Next to the risk rating column, a risk ranking should also be recorded using the categories in the key.

Table 3 - Risk Scoring Table LIKELIHOOD CONSEQUENCES

Negligible - 0 Minor - 1 Moderate - 2 Serious - 3 Major - 4 Critical - 5 Impossible 0 Rare 1 Unlikely 2 Moderate 3 Likely 4 Certain 5

0 0 0 0 0 0
No risk Employee

0 1 2 3 4 5
Low risk

0 2 4 6 8 10

0 3 6 9 12 15
Moderate risk

0 4 8 12 16 20
Significant risk Service Manager

0 5 10 15 20 25
High risk Director/Trust Board

KEY: Acceptance level

Local manager

Action Plan and Risk Register An action plan should be prepared after an assessment has been made. Studies have shown that training is a relatively ineffective method of control, and therefore should only be considered after other methods. A general guide on the effectiveness of controls is in descending order of effectiveness: Eliminate the risk Substitute the risk activity with a less risky method Use physical barriers to prevent the escape of energy which would lead to injury loss or damage Use procedural methods to prevent the injury loss or damage Protect at source the person, property or data from loss Training in safe ways of working Based on active consideration of the options for controlling that risk to and acceptable level of residual exposure; Promulgated to all those who need to know about the controls;

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

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Regularly reviewed to consider whether they continue to be: o Effective o The best value for money response to the risk o Documented by the relevant managers

If line management are unable to manage the risk, it should be referred using the form to the local risk management committee where it exists or the Trust risk management committee. The risk should be presented to the committee along with other risks on the risk register at the same time, and a comparison drawn. The Trust committee should compare the risks against existing by either considering the position on the register, or by comparing the relative costs of reducing risks on the register. For example a risk in the category 'High' with a score of 16 may cost 10,000 to reduce to the level of moderate with a score of 6. This may be compared to a risk in the category 'High' with a score of 20 which costs 500,000 to reduce to the level of 'moderate' with a score of 9. On a cost-benefit argument the committee may decide to approve control for managing the first risk rather than the second. Inter-dependencies between risks will be described in the risk register for all risks rated High or above. Communication At all stages of the assessment it is important that those who were first involved in assessing the risk are informed of decisions relating to the management. This should be through line management, team meetings and feedback from the respective committees. Staff should have access to records of the assessment in a risk assessment folder where preliminary, focussed and general risk assessments with agreed action plans are stored. These records should be shared with staff working in the department and for new staff, including temporary and agency staff. Training Managers and local risk assessors will be offered training in their roles. This will include reference to the need for risk assessment, explanation of the risk management process, description of the risk assessment forms, more detailed information about the types of risks which require assessment, how risks are communicated throughout the organisation and the importance of feedback. Assessors will be required to attend refresher courses bi-annually.

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

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RMPA01 Preliminary Risk Assessment form Ward/service Names of those involved in the assessment Ward/Service Manager name Date of assessment

APPENDIX A

To be completed by ward/service manager I accept the findings of this assessment: (make amendments if required before signing) Signed Review assessment date

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

Risk assessment
The following areas require a full general assessment of risk Bathing (scalding) Clinical risks i.e. risks arising out of the provision of clinical care, e.g. blood transfusion, medication, medical devices, absconsion, communication of clinical information, infection Environmental including fall from a height, slips and trips Fire, including arson Hazardous substances including chemicals, legionella, mercury, asbestos Hot surfaces Lone working (other than violence and aggression - see below) Moving and handling Repetitive strain injury e.g. from use of VDU or ultrasound Personal protective equipment e.g. masks, gloves Security of building or property Violence and aggression and self harm Other (Please specify)

Staff

Patients

Contracted staff (e.g. domestics)

Others inc visitors

Property

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RMSRA01 Moving and Handling Checklist Ward/service Names of those involved in the assessment Ward/Service Manager name Date of assessment

Appendix B

To be completed by ward/service manager I accept the findings of this assessment: (amend as necessary before signing) Signed Review assessment date
Adequacy of existing controls
Inadequate Not applicable Adequate

Risk assessment reference number (from general assessment form)

Risk being considered Are particularly heavy loads being carried Do patients/clients require manual handling Do staff assist patients/clients to stand/walk Do we provide assistance to patients/clients during transfers Do we provide assistance in bathing the patients/clients Are loads dangerous sharp, bulky, unstable, hot or cold Does staff lift while twisting Do staff bend forwards or sideways while lifting or carrying Do staff need to hold loads out at a distance Is there a risk of sudden movement Are surfaces liable to cause slips or trips Do space constraints preventing good technique Are objects stored on the floor/above shoulder height Is there repetitive manual handling Are loads being carried a long distance Can staff get a good grip of the load Are there enough members of staff to carry out the task safely Other

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RMSRA02 Self Harm Checklist Ward/service Names of those involved in the assessment Ward/Service Manager name Date of assessment

Appendix C

To be completed by ward/service manager I accept the findings of this assessment: Signed Review assessment date
Adequacy of existing controls
Inadequate Not applicable Adequate

Risk assessment reference number (from general assessment form)

Risk being considered Describe the type of client and departmental approach/ethos to preventing self-harm:

Drugs Securely stored and access keys managed Drugs Administration, storage, stock checking, disposal, which are communicated and followed by all relevant staff Drugs Procedures in place for use of patients own medication Chemicals e.g. cleaning Securely stored Chemicals suitable quantities taken into patient areas Sharp objects access controlled to knives, kitchen implements, cutlery, glass, crockery, razors etc. Sharp edges on furniture, doors etc 21

Ligature points e.g. access to cords, curtain rails, hooks of any description, door closure mechanisms, door hinges, light fittings, shower heads and fittings, towel rails, mechanisms in windows, clothes rails in wardrobes, handles of any type, anything hanging from the ceiling e.g. sign boards Falls from windows, drops greater than 2m etc Mechanical equipment e.g. Hoovers, cleaning equipment Electricity e.g. radios, kettles, light fittings, sockets. Electric circuits protected by RCDs (Residual circuit devices). Ignition sources e.g. cigarette lighters, matches and combustible materials e.g. bedding, books etc. Trapping points in doors, windows etc Water risks of drowning, e.g. baths Other

Note: This is not a complete / comprehensive list of potential risk areas of self harm, and is only considered to be a guide to assist with the risk of self harm within a unit / location.
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RMSRA03 Hot Surfaces Checklist Ward/service Names of those involved in the assessment Ward/Service Manager name Date of assessment

Appendix D

To be completed by ward/service manager I accept the findings of this assessment: Signed Review assessment date Adequacy of existing controls Not applicable Inadequat e Adequate Risk assessment reference number (from general assessment form)

Risk being considered Note: Always check for local policies re Safe bathing.

Items which may be touched or handled: Ovens/Cooker/Microwave/Toaster/Kettle Laundry iron Tea boiler/water heater/Coffee machine Sterilizer Hot taps Surfaces which may be leaned/trapped against Radiators Exposed hot pipes e.g. for radiators Electric heaters Other

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RMSRA04 Physical Security Checklist Ward/service Names of those involved in the assessment Ward/Service Manager name Date of assessment

Appendix E

To be completed by ward/service manager I accept the findings of this assessment: Signed Review assessment date
Adequacy of existing controls Inadequate Not applicable Adequate

Risk assessment reference number (from general assessment form)

Risk being considered External environment: locks, lighting, view holes, alarm systems
Poor external lighting Overgrown landscaping (bushes, trees etc)

Blind corners External physical security Too many entry points Unsecured doors and windows

History of vandalism or break in Internal physical security Unsecured valuable property e.g. cash, drugs, IT equip Property not recorded No alarm system Lack of vision panels on doors Poor internal lighting Isolated areas of the building

Valuables on view to the outside Internal procedural security Other

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RMSRA05 Workplace Checklist Ward/service Names of those involved in the assessment Ward/Service Manager name Date of assessment

Appendix F

To be completed by ward/service manager I accept the findings of this assessment: Signed Review assessment date
Adequacy of existing controls Inadequate Not applicable Risk assessment reference number (from general assessment form)

Risk being considered

Light levels too high, too low or there is glare Temperature too high or too low Poor ventilation not enough or draughty Hot water Cold surfaces Hot surfaces Confined spaces Surfaces liable to cause slips or trips Working at height Obstructions such as low ceilings Risks of falling objects or objects too high to safely handle Working with gases Working with or near dusts, including asbestos Electrical cables and equipment Pressurised equipment e.g. pumps, cylinders Moving parts of equipment Space to move around the area Segregation of people from traffic Other

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Adequate

RMSRA06 Lone Working Checklist Ward/service Names of those involved in the assessment Ward/Service Manager name Date of assessment

Appendix G

To be completed by ward/service manager I accept the findings of this assessment: Signed Review assessment date
Adequacy of existing controls

Inadequate

Home visits arrangements are in place for: First time visits Follow-up and ongoing visits to known risk client/area Monitoring staff itinerary Work in poor lighting or visibility (e.g. winter months) Emergency contact Animals Carrying cash or drugs Visits to isolated areas/communities

Vehicle breakdown Clinics/surgeries arrangements in place for: Protection of lone staff/staff in isolated parts of the building Protection of staff in isolated clinics/surgeries

Working in clinics in a known risk area Facilities staff (in addition to the above checklist) arrangements in place for: Hazardous tasks incl work with chemicals or gases Electrical work Working at height Other

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Adequate

Risk being considered

Not applicable

Risk assessment reference number (from general assessment form)

RMSRA07 Computer Assessment Name: Location: Assessor: Section 1, User Assessment 1. Is the use of DSE* a prime function of the job? 2. How frequently is the DSE used? Tick as applicable Yes No Every day Most days Every 2/3 days Weekly Occasionally Over 4 hours 2-4 hours 1-2 hours 30 minutes 1 hour Up to 30 minutes Over 4 hours 2-4 hours 1-2 hours Up to 1 hour Yes No Yes No Total points Job Title: Organisation: Date:

Appendix H

Points 3 0 5 4 3 2 1 5 4 3 2 1 10 8 2 1 3 0 0 3

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

4. How many hours a day of continuous key depressions?

5. Does the job require formal typing skills? 6. Can regular breaks be taken at the Users discretion? *DSE = Display Screen Equipment Score 13 or less 14 - 18 19 or more Classification Low risk user Medium risk user High risk user

Priority for change Low, make any easy changes now Medium, make any easy changes now High, arrange to make changes ASAP

Please note that this is not a definitive calculation of risk and is purely a guide to your assessment
Version Aug 04

FORM TO BE RETAINED BY MANAGER

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Section 2, Computer assessment

Yes No Additional information / Recommendations

1
1.1 1.2 1.3 1.4 1.5 1.6

User position
Is the User facing the keyboard and screen? Are the Users eyes level with the top third of the screen? Is the keyboard and mouse within easy reach? Are the Users arms fore-arms roughly horizontal and at right angles to their upper arms? Is the User sitting upright? Can user rest his/her feet comfortably on the floor without a footstool? (If no a footstool is required)

2
2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11

Chair
Is the chair back adjustable? Does it give firm support to the lower and middle part of the back? Does the chair base have 5 feet? Is the chair height adjustable? Are armrests in position? Do they inhibit the user? Adequate padding on chair? Wide enough to seat large members of staff comfortably? Deep enough to support legs of tall people, but not too deep for shorter users (leading to the back-rest not being used). Is the chair surface hollowed or deeply shaped, making it harder to get up or change position? Is the front of the chair rounded over?

3
3.1 3.2 3.3

Workspace
Allows flexible arrangement of screen, keyboard, mouse etc ? Adequate clearance underneath the workspace for thighs, knees, lower legs & feet ? Does it have a low reflective surface?

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Yes
3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 Is there adequate space for paperwork? Are there any distracting noises? Heat (min 16C)? Ventilation adequate? Access / egress re disabled users? Are there any tripping hazards? (Trailing cables/loose floor tiles) Walkways clear? Is the telephone easy to reach? (If the Users right-handed the phone should be on their left side and vice versa)

No

Additional information / Recommendations

4
4.1 4.2 4.3

Lighting
Adequate? Is there glare or reflections on the screen? Are blinds/curtains available to reduce this?

5
5.1 5.2 5.3 5.4 5.5 5.6

Keyboard
Is the angle of tilt adjustable? Are the characters legible? Is it comfortable to use? Is it too far back from the edge of the desk, causing user to haunch over? Is it in front of the user, with at least 50mm of space in front of the keyboard to allow for hand/ wrist support? Are the Users wrists in line with their forearms?

6
6.1 6.2 6.3 6.4

Mouse
Fits hands comfortably? Works efficiently? Located adjacent to the keyboard? Is the operator using the mouse correctly?

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Yes 7
7.1 7.2 7.3 7.4 7.5

No

Additional information / Recommendations

Screen
Can the screen swivel and tilt? Does it have a stable image? Are the characters clear? Is it clean? Brightness and background of the screen adjustable?

8
8.1 8.2

Document Holder
Does the User input text from paper on a regular basis? (if yes, a document holder is required) Is it correctly positioned?

9
9.1 9.2 9.3 9.4

Software
Is the software appropriate for the task? Is the mouse required frequently? Can shortcut keys be used? Has the User been trained to use the software?

10
10.1 10.2 10.3 10.4 10.5 10.6

Individual Conditions
Does the work routine allow for regular breaks or changes of activity? Does the User suffer from regular headaches? Does the User have back problems? Does the User get blurred vision regularly? Does the User get sore eyes regularly? Does the User know if they need glasses for DSE use?

Users signature Assessors Signature Managers name Signature Date received

Date Date

Date actioned

Please note that this is not a definitive calculation of risk and is purely a guide to your assessment
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FORM TO BE RETAINED BY MANAGER

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RMSRA08 Clinical Risk Checklist Ward/service Names of those involved in the assessment Ward/Service Manager name Date of assessment

APPENDIX I

To be completed by ward/service manager I accept the findings of this assessment: Signed Review assessment date
Adequacy of existing controls
Inadequate Not applicable Adequate

Risk being considered Blood Transfusion policy Handling arrangements Training Sharps handling and disposal Consent Clear guidance on when written consent required Information for clients Competence of staff gaining Training Staff competency Staff registration recorded and up to date Clinical supervision Training records and plans Clinical record keeping Standardised records Accessible to relevant staff Confidentiality Adequate storage Retrieval Policy Audit Resuscitation Clear policy and procedure Equipment suitable, available and checked Clear links and liaison with crash team/ambulance Training

Risk assessment reference number (from general assessment form)

31

Medical devices and equipment Suitable for tasks Records of equipment and trace ability Information on safe operation Training for staff Maintenance arrangements Fault reporting Local procedure for Safety Action Broadcasts Medicines and vaccine Prescribing Safe storage/carriage Dispensing arrangements (convenience and safety of container) Information and warnings for user Administration Disposal of waste drug/vaccine Mental health specific:

Standards of Observation on In-patient Wards Leave for Informal Patients Policy Communication of Risk (to other Agencies and Services) Policy Policy on Non-attendance Policy on Absconsion Policy on Non-compliance with Treatment Regimes Use Trust approved Care Pathway Approach Maternity Profile Maternity Risk Strategy Guidance for Obtaining Consultant Advice Guidance for Transfer to Acute setting Terms of Reference and minutes of the Labour Ward Forum Policy for CTG training

Maternity specific:

Version 7 Dated Aug 04

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RMSRA09 Violence and Aggression Checklist Ward/service Names of those involved in the assessment Ward/Service Manager name Date of assessment

APPENDIX J

To be completed by ward/service manager I accept the findings of this assessment: Signed Review assessment date Adequacy of existing controls
Inadequate

Risk being considered

Physical security Good lines of sight e.g. cannot walk into blind spots including rooms without seeing in first Escape routes for staff in high risk areas Suitable protection in reception areas Adequate lighting Potential missiles Information Appropriate signage including Chief Executive notice on aggression to staff Clear and easy to follow signage Staff clear about when and how to inform patients of delays Letters give enough detail about visits New carers/patients given information about the area, visiting times etc Action in case of violent incident: Clear procedure Means of raising the alarm, attack alarms etc Clear identification of incident location Responding staff trained and up to date in their role Procedure for obtaining further assistance e.g. security or police Training Customer care Challenging behaviour Breakaway Restraint Other

Version 6 Dated Aug 04

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Not applicable

Adequate

Risk assessment reference number (from general assessment form)

RMSRA10

Appendix K New and Expectant Mothers at Work Risk Assessment

Surname

First Name

DoB Contact Tel:

Managers name (please print) Department: Occupation: Please select as appropriate: Please select

Hours of work if is currently pregnant: Expected date of delivery: No. of weeks pregnant:

Work Activates (Attach job description if possible) Hazards Identified PHYSICAL Control Measures implemented & Recommendations

BIOLOGICAL

CHEMICAL

WORKING CONDITIONS

Additional information

34

Are there adequate and suitable facilities for rest breaks? Is the employee able to take sufficient rest breaks during her shift? Has the employee been issued with any medical advice by a medical practitioner/midwife? If yes, refer immediately to the Occupational Health Department. Has the employee any concerns about their health? If yes, refer immediately to the Occupational Health Department. Date of Assessment: Assessors Name: Employees Name: Review Date: Signature: Signature:

YES YES

NO NO

YES

NO

YES

NO

To be completed by ward/Service Manager: I accept the findings of this assessment Signed Copies to Review assessment date Employee Manager Occupational Health Department (OHD) North Cambridgeshire & Peterborough 53 Thorpe Road Peterborough Cambridgeshire PE3 6AN Tel: 01733 316519 Fax: 01733 316529

OHD contact details:

Maternity form v 2/8/04

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RMSRA11 Chemicals Checklist Ward/service Names of those involved in the assessment Ward/Service Manager name Date of assessment

APPENDIX L

To be completed by ward/service manager I accept the findings of this assessment: Signed Review assessment date Adequacy of existing controls
Inadequate

Risk being considered Biological agents e.g. clinical waste, sharps Cleaning agents e.g. bleach Dental compounds Disinfectants Fixing agents e.g. formalin Fuel / Maintenance oils e.g. diesel, grease Gases e.g. carbon dioxide Latex e.g. gloves especially powdered Liquid gases e.g. cryotherapy Mercury e.g. thermometers, sphygmomanometers Paints / resins e.g. used in Art Therapy Significant dusts / fibres e.g. concrete, wood Smoking X-ray chemicals Other

Version 3 Dated Aug 04

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Not applicable

Adequate

Risk assessment reference number (from general assessment form)