Maternity Risk Assessment
To be completed by manager
Employee Name
*
First Name
Last Name
Date of Risk Assessment
*
-
Day
-
Month
Year
Date
Physical Job Demands
Does the work involve lifting or pushing heavy objects?
*
Yes
No
Other
Does the work involve standing or squatting for long periods?
*
Yes
No
Does the role involve a lot of walking?
*
Yes
No
Does the work involve working at height or climbing steep steps?
*
Yes
No
Does the employee need access to areas with limited space?
*
Yes
No
Will any tasks become more hazardous as the employee changes shape and size throughout pregnancy?
*
Yes
No
Does the role involve shift work?
*
Yes
No
Does the role involve working at night?
*
Yes
No
Mental Job Demands
Does the job involve meeting challenging deadlines?
*
Yes
No
Does the role involve rapidly changing priorities and demands?
*
Yes
No
Does the role require a high degree of concentration?
*
Yes
No
Working Conditions - General
Does the work involve lone working or working in remote locations?
*
Yes
No
Does the role involve any home working?
*
Yes
No
Are toilet facilities easily accessible to a pregnant worker?
*
Yes
No
Is the worker able to take toilet breaks when necessary?
*
Yes
No
Can the worker take rest breaks when needed?
*
Yes
No
Can the worker control the pace of her work?
*
Yes
No
Does any part of the job involve dealing with members of the public?
*
Yes
No
If so, does it involve with dealing with distressed or disturbed people?
*
Yes
No
Does the role involve:
*
Working with young children or sick people?
Unpredictable working hours?
Dealing with emergencies?
Are there any obstacles in corridors or offices that could cause problems for pregnant women e.g in the event of a fire evacuation?
*
Yes
No
Is the workplace non smoking?
*
Yes
No
If not, is the worker separated from any designated smoking area?
*
Yes
No
Is there any other form of indoor air pollution?
*
Yes
No
Is the temperature in her working environment reasonable?
*
Yes
No
Is there enough room for the worker to get in and out of her workstation?
*
Yes
No
Does the worker have an adjustable seat with a backrest?
*
Yes
No
Specific Hazards
Does any part of the job involve use of chemicals?
*
Yes
No
If so, are there any risks to the employee whilst she is pregnant or a nursing mother?
*
Yes
No
Is there any exposure to vibration e.g through the use of hand tools?
*
Yes
No
Does the employee need to wear any personal protective clothing?
*
Yes
No
If so, will this present a problems as the pregnancy develops?
*
Yes
No
Person completing the risk assessment
*
First Name
Last Name
Signature
*
Position
*
Any additional notes or comments
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