Expectant Employee Risk Assessment Form

Does the employee's work involve exposure to or work with any of the following?    

1. Excessive Noise        
2. Chemicals (drugs, specific chemicals such as lead, pesticide, Lab chemicals with
3. the following Risk Phrases R40 R45 R61R63 and R64)        
4. Biological Agents (in particular infectious diseases}        
5. Nauseating smells        
6. Vibration or Shocks        
7. Manual Handling (Lifting or carrying heavy loads)        
8. Extreme Cold Environment        
9. Extreme Hot Environment        
10. Non-ionizing radiation optical radiation (ultraviolet (UV), visible and infrared) and
11. Electromagnetic fields power frequencies microwaves and radio frequencies.        
12. Shift work ( early or late)        
13. Awkward spaces and workstations        
14. Abnormal movements or postures        
15. Travel e.g. long journeys, air travel, etc.        
16. Use of protective clothing        
17. Difficulty in leaving the job for breaks etc.        
18. Work in Hyperbolic atmospheres e.g. pressurized enclosures and underwater diving        
    

Where you Tick YES, please identify the proper control measures, if necessary consult the Health & Safety Officer for Advice.

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Expectant Employee Risk Assessment Form