Cuerden Leisure
PREGNANT, POST NATAL OR BREASTFEEDING EMPLOYEES HEALTH AND SAFETY CHECKLIST
(please tick appropriate box)
Y
N
Does the work involve:
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Lifting or pushing heavy boxes?
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Standing or squatting for long periods?
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A lot of walking?
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Working at height or climbing steep steps?
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The need to access areas with limited space, e.g. store rooms?
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Will any task become more hazardous to the worker’s changing shape and size?
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Does the role involved shift work? If so, does it involve work at night or into the night?
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Physical Job Demands
Mental Demands
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Does the job involve meeting challenging deadlines?
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Does the role involve rapidly changing priorities and deadlines?
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Does the role require a high demand of concentration?
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Working Conditions – general
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Does the work involve lone working or working in remote locations?
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Does the role involve any home working?
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Are the toilet facilities easily accessible to a pregnant worker?
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Is the worker able to take toilet breaks when needed?
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Can the worker take rest breaks when needed?
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Can the worker control the pace of her work?
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Are there any risks of violence at work?
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Does any part of the job involve dealing with members of the public?
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If so, does it involve dealing with distressed or disturbed people?
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Does the role involve:
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Contact with young children or sick people?
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Unpredictable working hours?
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Dealing with emergencies?
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Are there any obstacles in corridors or offices that could cause problems for
pregnant women, e.g. in the event of fire evacuation?
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Is the workplace no smoking?
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If not is the worker separated from any designated smoking area?
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Is there any form of indoor air pollution, e.g. diesel fumes?
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HSI
016
F
Version 1
June 2009
Page 1 of 2
Cuerden Leisure
PREGNANT, POST NATAL OR BREASTFEEDING EMPLOYEES HEALTH AND SAFETY CHECKLIST
(please tick appropriate box)
Y
N
Work conditions – general (contd)
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Is the temperature in her working environment reasonable?
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Is there enough room for the worker to get in and out of her workstation?
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Will there still be enough room as pregnancy develops?
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If applicable has she had a DSE workstation assessment?
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4. Specific Hazards
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Does any element of the job bring her into contact with substances hazardous to
health e.g. chemicals
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If so has a COSHH assessment taken place and is it known to be hazardous to
the worker whilst she pregnant or nursing?
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Is there any exposure to vibration, e.g. through hand tools or excessive driving?
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Does the worker require the use of Personal Protective Equipment to carry out
their work?
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If so will this cause any problems as the pregnancy develops?
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Additional Information (please print details below)
Name of new or expectant mother:
Name of Assessor:
Division: (e.g. Crown/Six Piers)
Site Location :
Job title:
Brief explanation of job outline or tasks carried out by person being assessed
HSI
016
F
Version 1
June 2009
Page 2 of 2