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Pregnancy Safety Audit and Risk Assessment
Name
(Required)
First
Last
Job Title
(Required)
Site/Location
(Required)
Date
(Required)
MM slash DD slash YYYY
Assessor
(Required)
General Risks/Hazards Assessment
Please select Yes or No if the employee may be exposed to the following risks Risk Evaluation = Having identified the hazards, the level of the risk will be assessed based on qualitative measures. The severity of the risk will either be termed as High, Moderate or Low. High: Extremely harmful e.g. (amputations, permanent loss of sight, major fractures, poisoning and gassing, fatal injuries, severe life-threatening disease, acute fatal diseases etc & major damage to property, equipment or to the environment.) Moderate: Harmful e.g. (laceration, serious cuts and bruises, burns, serious sprains, minor fractures, occupational deafness, dermatitis, allergy, repetitive strain injury ill health leading to permanent disability etc, and serious damage to equipment, property, or the environment). Low: Slightly harmful e.g. (superficial injuries, minor cuts and bruises, eye irritation, ill health leading to temporary minor disability etc, minor damage to equipment, property, or the environment
Physical shocks
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
Vibration
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
Handling a load
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
Excessive heat or cold
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
Noise
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
Abrupt movement/ posture causing fatigue
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
Ionising radiation
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
Non-ionising radiation
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
Biological Hazards & Agents
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
Chemical Hazards
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
Stress and /or bullying
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
VDU/ workstation ergonomics
(Required)
YES
NO
N/A
Evaluate the risk
(Required)
HIGH
MODERATE
LOW
Note the controls in place to reduce/remove the risk
(Required)
Risks Specific to Pregnancy
Please select Yes or No if the employee may be exposed to the following risks
Pressurisation chamber
(Required)
YES
NO
N/A
Rubella Exposure (unless adequately immunised)
(Required)
YES
NO
N/A
Toxoplasma exposure * infection usually occurs by eating undercooked contaminated meat, exposure to cat faeces
(Required)
YES
NO
N/A
Underground mine work
(Required)
YES
NO
N/A
Lead or lead substances
(Required)
YES
NO
N/A
Physically demanding tasks (e.g., heavy lifting)
(Required)
YES
NO
N/A
Areas Audited
Areas with access
Areas without access
Additional notes or requirements
