Risk Assessment for High Risk and Vulnerable Student Groups with potential

work related exposure to COVID-19

The Information provided in this Form will only be used to determine whether any
reasonable adjustment is required to facilitated student placement within the Trust and can
be shared with the Trust Bank Nursing to ensure student safety

Please read the attached guidance for Risk Assessment for High Risk and Vulnerable Staff Groups with potential work
related exposure to COVID-19
Name of student being assessed: Ethnic Group:White Post:

University:Buckinghamshire New Student Nurse

University
Cohort:Sept 2018 Year of Birth: 1983
Mob:07411985936
Email: ultra.spike42@gmail.com
Manager Name: Placement area / Ward: Date of Assessment / Review :
Caroline Foley Roundwood Suite 01/02/2021
Angelyna Peters A&E NPH
Farouk Lalljee
Step 1: Determine Vulnerability Group (Please tick) (See appendix 1 of attached guidance)
Vulnerable staff due to: Age 60+ / BAME / Underlying Medical Condition / Male / Disability / Pregnant
x <28 weeks with no underlying health conditions GO TO STEP 2
Staff in the very high risk groups and pregnant >28 weeks gestation or pregnant <28 weeks with an
underlying health condition must shield. GO TO STEP 4 TO CONFIRM SHIELDING WILL BE IN
PLACE
List Of Medical Conditions

List Of Medications And Doses You Are Currently Prescribed:

Body Mass Index

Or
Height & Weight 181cm/94kg

Are you Currently under Review with a Specialist

Did you get a shielding letter?

If yes from whom your GP/Specialist or other

Step 2 – Define Area of Work

 Clean Zone: Confirmed non-Covid
wards, Corridors, Offices, Public
spaces, restrooms
Clean Zone
Vulnerability Group:
Age 60+ [ ]
Medical condition [ ]
BAME [ ]
Pregnant < 28 weeks without
severe risk [ ]
Male [ ]
Disability [ ]
If you have selected one or more
group/s, you fall into a low risk
category.
Go to 2A below and then go to step 3
2A Key considerations
Whether public transport / rush hour
can be avoided through adjustments
to work hours or getting a taxi [x ]
Drive to work [ ]
Book accommodation [ ]
Enable remote working if possible [ ]
Step 3 Outcome:
Low Risk:
Work in clean zones.
Key considerations implemented and
staff member works with adjustments
in place
Once completed provide a copy to the staff member lnwh-tr.hrcovidqueries@nhs.net. It is the manager’s
responsibility to keep this under review.
Green Zone: Clinical areas where AGPs
are not being undertaken however could
still be treating Covid patients
Green Zone
Vulnerability Group:
Age 60+ [ ]
Medical condition [ ]
BAME [ ]
Pregnant < 28 weeks without severe
risk [ ]
Male [ x ]
Disability [ ]
If you have selected any group you fall
into a moderate risk category.
Go to 2A & 2B and then go to step 3
2B Steps that must in place
Check and confirm:
Staff Member is trained to use
appropriate PPE [x ]
Staff Member is confident & Competent
in using appropriate PPE [x ] If no
consider re-training
Staff Member is fit tested if required [ ]
Appropriate PPE is available at all times [
] bone e.g. surgical drilling
Students are advised to ask for
practical demonstration Donning and
Doffing procedure at the very start of
placement on allocated ward.
Moderate Risk:
Staff who are pregnant and
working in the green zones must
be moved to Blue zones with
immediate effect.
Selected one or two groups and
work in green zones:
Continue to work in Green Zone as
long as steps in 2A and 2B have
been implemented.
Selected two groups or more (1
to include underlying health
condition) and work in green
zones:
Complete risk assessment and refer
Red Zone: Aerosol Generating
Procedures
Minimise people working in the
area
Red Zone
Vulnerability Group:
Age 60+ [ ]
Medical condition [ ]
BAME [ ]
Pregnant < 28 weeks without
severe risk [ ]
Male [x ]
Disability [ ]
If you have selected any group
you fall into a high risk category.
Go to 2A, 2B & 2C and then go
to Step 3.
2C: Definition of High Risk
Aerosol Generating
Procedures (AGPs):
Coronavirus is infectious
spread through moisture
droplets
- Check the AGP agreed list
- For dentistry and post
mortem specific advice
should have been provided
to managers
- Aerosolisation of blood and
- Nebulisers are not AGPs
The 2m safe distance does not
apply when performing AGP on
respiratory system and anyone
in the room can be exposed
High Risk:
Staff who are pregnant and
working in the red zones must
be moved to Blue zones with
immediate effect.
Selected one or two groups and
work in red zone:
Continue to work in Red Zone as
long as steps in 2A, 2B, 2C
outlined have been implemented
Selected two groups (1 to
include underlying health
condition) and work in red
zones:
Complete risk assessment and
 to OH for advice if required and refer to OH for advice but redeploy
consider options such as to a lower risk area whilst awaiting
redeployment to lower risk area. outcome.

Step 4 - Agreed Actions: Please specify

Students are advised at induction:

1. to ask for practical demonstration of Donning and Doffing procedure at the very start of
placement on allocated ward.
2. To request Fit testing and wear appropriate enhanced PPE Equipment prior to engaging
with AGP.
3. To request a review if any you (student) develop any medical condition
4. On Uniform policy – No uniform when travelling and laundering at 50 degrees & above.
5. Work shoes - Wipe with Chlorine wipe to keep it clean, Keep secure in bag when not at
work to reduce spread of infection.

Manager Signature

Student’s Signature Gareth McKnight

Date 01/02/2021

If the outcome is moderate to high risk staff member may need to be referred to
occupational health. Please email LNWH-tr.OccupationalHealth@nhs.net attaching the
Occupational Health completed risk assessment form and covering email with specific questions related to this
Support risk assessment. Please ensure the contact details for manager and the relevant member
of staff is up to date.

Once completed provide a copy to the staff member lnwh-tr.hrcovidqueries@nhs.net. It is the manager’s
responsibility to keep this under review.