APPENDIX A: MATERNITY RISK ASSESSMENT TEMPLATE FOR NEW OR EXPECTANT MOTHERS

Expectant or new mother risk assessment for: Reference:

Name: [Name of employee] Contact

number:

Job role: Department /

location:
(including typical
tasks)

Expected date of Actual date of

delivery: birth: (new
(expectant mothers) mothers only)

Manager completing Initial

assessment: assessment
date:

Any health / wellbeing

issues:

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Risk assessment for an expectant or new mother: Hazards and controls

Significant Perceived Generic Residual Additional Managers Comments

Hazard Nature of Control Risk/Low Control
Risk Measures Medium/High Measures

Display Screen Increased DSE assessment to be undertaken if not Review DSE

Equipment susceptibility to already in place. Workstation should provide Low assessment
musculoskeletal adequate adjustment to allow for increase in as pregnancy
disorders and deep abdominal size. Advice on posture to prevent progresses
vein thrombosis (DVT) musculoskeletal problems. Adjust working
practices to avoid continuous sitting at
workstation (risk of DVT)

Slips, Trips & Increased risk of injury Maintain high standards of housekeeping in
Falls due to physical change work area. Low
and or hormonal Individual may have difficulty negotiating
changes stairs during later stages of pregnancy

Lifting and Musculoskeletal injury Reduce amount of physical work associated

Carrying Loads Weakening of the with task. Low
skeletal structure Physical tasks become more difficult to
achieve as pregnancy progresses
Carrying heavy loads to be avoided

Welfare Access to toilets to Provision of easy access to toilet facilities Low Agree
protect against risk of and more frequent breaks from work activity provision of
infection and kidney Consideration should be given to providing suitable rest
disease access to quiet area where the individual can facility as
rest as necessary necessary

Fatigue Fatigue from Avoid long periods of time standing. Task

prolonged standing or modified to provide seating or more frequent Low
physical activity rest periods.

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 Aspects of the work may need to be modified
as physical capability will reduced as a result
of pregnancy
Work Related Individual vulnerable to Monitoring and reduction of risks in relation to
Stress stress due to work demands, relationships with colleagues Low
hormonal, / manager and requirements of the role.
psychological and
physiological changes
during pregnancy
Temperature / Lower tolerance to Temperature of the working environment to Provision of
Humidity heat and humidity be suitably controlled. Low equipment to
resulting in discomfort Individual may require access to fresh air for provide local
/ faint periods during the working day. Individual to heating /
have ready access to fresh drinking water cooling as
necessary

Out of Hours Long working hours or Allowance made for tiredness and nausea at
Working shift work patterns can early stages of pregnancy. Low
affect the health of Consult with occupational health and
pregnant women. individual on modification to working hours /
avoidance of night work

Personal Safety Violence or fear of If their is a perceived risk of violence or threat

violence can increase of violence / abuse consideration needs to be Low
given to modifying the role to reduce the risk
to the individual and or make provision for
staff to be available should support be
required

Access / Egress Mobility may be Seek to modify the individuals work task to Low PEEP
impaired during later avoid walking significant distances or assessment
stages of pregnancy traversing flights of steps. should be
completed
with health
and safety
team

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 Working at Loss of agility and or Modify task to avoid aspects of working at Low
Height balance height

Increased medical risk UK Travel

from business travel. Travel arrangements should include
Travel Health Poor posture / adequate provision for rest breaks during the
prolonged sitting journey.
increase risk of deep Travel times chosen to reduce levels of Med
vein thrombosis (DVT) fatigue. Carry out regular stretching exercises
Risk from infectious on flights. Drink sufficient fluids.
diseases in some The use of graded compression stockings.
countries Loose-fitting clothing to avoid constriction of
veins.

International Travel
Health risks to be further assessed with
advice from a medical practitioner /
occupational health. Med
Travel to be scheduled to avoid restrictions
imposed by airlines on pregnant women
(typically past 32 weeks).
Carry out regular stretching exercises on
flights. Drink sufficient fluids.
The use of graded compression stockings.
Loose-fitting clothing to avoid constriction of
veins.

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Biological or Exposure to certain New or Expectant mother must not be
biologicals e.g. exposed to biological agents. Consider
bacteria, viruses, alternative tasks to working environment
moulds, fungi. where exposure is recognized

Chemical Exposure to certain New or Expectant mother must not be

Chemicals; dust, exposed to chemical agents. Consider
fumes, gas vapour, alternative tasks to working environment
mist, liquids where exposure is recognized.
solids, fibres

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Risk assessment for an expectant or new mother: Further actions required

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Risk assessment for an expectant or new mother: Risk Assessment Review
Action to be taken to further reduce risk Person responsible for Target completion date Action closure
completing action
(Prioritized on risk)

Date Priority Signature Date

Review DSE assessment as pregnancy progresses DSE Assessor

Agree provision of suitable rest facility if necessary Manager of work area

Provision of equipment to provide local heating / cooling if Manager of work area /

necessary E&FM

Additional procedures for lone working / working off site Manager of work area

PEEP assessment form to complete Safety Adviser for the work

area

Seek advice from medical practitioner / Occupational Health Manager of work area
before making International travel arrangements

Date Employee signature Manager signature

Initial risk assessment

completed:

Proposed date for next

assessment:

Assessment reviewed on:

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