Section 3

Manual Handling
Risk Assessment
Information

Manual Handling Risk Assessment People 2012 21

 Manual Handling Risk Assessment General Information

The Manual Handling Operations Regulations 1992 require all hazardous manual
handling situations to be avoided wherever possible. Those hazardous situations
which cannot be avoided must be assessed and action taken to reduce the risk of
injury to the lowest level ‘reasonably practicable’.
Reasonably practicable means until the cost of further precautions (in time, trouble or
money) would be far too great in proportion to the benefits.

The Manual Handling Risk Assessment Folder (MHRAF) contains the manual
handling risk assessments for each ward/department. It is the responsibility of each
member of staff to ensure that they are aware of the assessments and any action
which needs to be taken.

Staff also have a responsibility to bring to the attention of their manager, any
hazardous manual handling situations which may not have been included in the
MHRAF.

In addition to the MHRAF, most clinical/patient handling areas will need to assess
individual patients and a special form is available for these assessments. In those
areas where there is a fast ‘throughput’, with minimal handling, then a generic
assessment will be completed in the MHRAF to cover those situations.

Manual handling risk assessment takes four factors into account. These are:
• the task: where is the patient/load being moved from and to
• the load: the patient (shape size weight capabilities etc.)
• the environment: space to move in with hazards removed
• the individual: the handler’s capabilities (experience, training, physical capacity)

All these factors have to be considered and ways of reducing risk implemented.

To minimise the risk of injury, lifting should be avoided where possible by use of the
most appropriate handling aids including; hoists, slide sheets, slide boards, trolleys,
sack truck etc.
(Under the Management of Health and Safety Regulations 1992 it is also a legal
requirement to use equipment, which has been provided, to minimise manual
handling risks).

The following pages give guidance on patient and load handling risk assessment and
ways of reducing risk.
There is also information on how to complete the patient handling assessment form.
 People Handling Risk Assessment
NB: The terms ‘people/person’ refers to the individual being moved (patient/client)
‘handler’ refers to the individual moving a person or load

A written manual handling assessment should be completed as soon as possible after

admission. Generally the Named Nurse who ‘admits’ the patient should complete this
initial assessment.

The written assessment is a guide to the moving and handling of the person.
However, the person’s capabilities and condition can change, sometimes within a
short space of time. This is why the person should always be assessed prior to
movement and if the status of the person is different from the recorded assessment,
then the assessment form should be amended.

When to Assess
As soon as possible after admission and thereafter when there is any change in the
person’s condition resulting in changes to the moving and handling.

Who to Assess
An individual assessment form should be used to assess the person or in some
areas, a generic risk assessments may be completed and recorded in the Manual
Handling Risk Assessment Folder (MHRAF).

Where to keep the Assessment Form

The form needs to be accessible to all personnel who may be involved in the moving
and handling of the person and its actual location may vary from one area to another.
The form should travel with the person when moving from one ward/department to
another e.g. people going to Medical Imaging etc.

To Determine the Level of Risk

A professional judgment has to be made based on the information ascertained. The
level of risk will depend on the handling factors present and the capabilities of the
person. As a person’s condition and capabilities may vary it can be difficult to classify
the level of risk into high medium or low.

However if a person requires any ‘hands on’ assistance, there is a potential risk to the
handler. Codes A (assistance) or U (unable) are used on the assessment form to
indicate this and because there is a manual handling risk, the patient movement plan
must be completed (Side 2 of the assessment form).

Manual Handling Risk Assessment People 2012 23

 Patient Handling Assessment Form Page One
This form can be found in the Combined Risk Screening and Assessment document.
Two versions are available – long stay (4 pages) and short stay (2 pages).

How To Complete The Form

The person’s name & address details should be recorded on the first page of the
document along with other basic details i.e. admission date, height and weight, BMI,
smoker/nonsmoker.

Complete other information: impaired hearing; sight

Complete assessment date and ward in relevant column

Handling Factors:
These are the factors which will influence the way the person moves or is moved. All
factors present must be identified by either putting a tick or comment in the box.

Unpredictable behaviour This will significantly increase the handling risks especially if the
person is violent or aggressive

Variable or non co-operation Indicate which.

Variable/ no comprehension Level of understanding will influence the handlers explanations

and commands

Pain Indicate the cause/site of pain if relevant

Pressure sore/wounds/at risk Indicate site or type of sore/wound or if none

present but person at risk state ‘at risk’

Type of mattress State type

Infusions/attachment to equipment If appropriate state attachment(s) e.g. catheter/drip etc.

Traction/splints etc. If a splint is worn intermittently state when worn e.g. night splint/
splint to mobilise etc.

Oedema State where

Patient for rehabilitation If yes, there may be an increased risk through encouraging the
person to do more for themself

Muscular spasm/rigidity If appropriate give details

Paralysis/weakness State where

Continence problems May affect use of equipment e.g. cleaning of hoist

slings/slidesheets etc.

History of falls: The person is a foreseeable risk of falling and ways of reducing
the risk must be addressed

Additional factors e.g. barrier nursing. This may affect e.g. use of equipment

Other State e.g. cultural influences

Mobility Factors Identify the person’s mobility levels
Insert the appropriate code* for each activity.

*Code
I = Independent. Person requires no assistance whatsoever

S = Supervision. Person requires verbal encouragement/physical presence of handler but no

assistance

A = Assistance. Person requires physical assistance of handler but able to help

U = Unable. Person requires assistance of handlers or hoist because unable to help.

If codes I and S have been identified for all activities, Page 2 of the assessment does
not need to be completed.

If codes A or U have been identified for one or more activities, Page 2 of the
assessment must be completed (relevant sections)

Assessors signature and designation

Ensure assessment is signed

Patient Handling Assessment Form Page Two

Patient Movement Plan
The information on this page indicates how the person can be moved safely and is
used for those people requiring assistance.

The date for each assessment should correspond with the dates on Page 1

Tick the appropriate box or fill in the information required. The number of handlers
required relates to the minimum number and should always be completed.

If a person is independent in certain activities this will be indicated on

the front sheet and those sections do not need to be completed on Page 2.

For example; a person may be able to move independently up the bed and across the bed, but needs
assistance with all activities out of bed.
The sections where assistance is not required would have N/A written through the assessment grid for
that assessment date.

When the assessment is complete, the assessor must sign it.

Reassess weekly and when there is a change in condition or situation (transfer of

ward).

Manual Handling Risk Assessment People 2012 25

 Section 3

Manual Handling
Risk Assessment
Information

Manual Handling Risk Assessment People 2012 21

 Manual Handling Risk Assessment General Information

The Manual Handling Operations Regulations 1992 require all hazardous manual
handling situations to be avoided wherever possible. Those hazardous situations
which cannot be avoided must be assessed and action taken to reduce the risk of
injury to the lowest level ‘reasonably practicable’.
Reasonably practicable means until the cost of further precautions (in time, trouble or
money) would be far too great in proportion to the benefits.

The Manual Handling Risk Assessment Folder (MHRAF) contains the manual
handling risk assessments for each ward/department. It is the responsibility of each
member of staff to ensure that they are aware of the assessments and any action
which needs to be taken.

Staff also have a responsibility to bring to the attention of their manager, any
hazardous manual handling situations which may not have been included in the
MHRAF.

In addition to the MHRAF, most clinical/patient handling areas will need to assess
individual patients and a special form is available for these assessments. In those
areas where there is a fast ‘throughput’, with minimal handling, then a generic
assessment will be completed in the MHRAF to cover those situations.

Manual handling risk assessment takes four factors into account. These are:
• the task: where is the patient/load being moved from and to
• the load: the patient (shape size weight capabilities etc.)
• the environment: space to move in with hazards removed
• the individual: the handler’s capabilities (experience, training, physical capacity)

All these factors have to be considered and ways of reducing risk implemented.

To minimise the risk of injury, lifting should be avoided where possible by use of the
most appropriate handling aids including; hoists, slide sheets, slide boards, trolleys,
sack truck etc.
(Under the Management of Health and Safety Regulations 1992 it is also a legal
requirement to use equipment, which has been provided, to minimise manual
handling risks).

The following pages give guidance on patient and load handling risk assessment and
ways of reducing risk.
There is also information on how to complete the patient handling assessment form.
 People Handling Risk Assessment
NB: The terms ‘people/person’ refers to the individual being moved (patient/client)
‘handler’ refers to the individual moving a person or load

A written manual handling assessment should be completed as soon as possible after

admission. Generally the Named Nurse who ‘admits’ the patient should complete this
initial assessment.

The written assessment is a guide to the moving and handling of the person.
However, the person’s capabilities and condition can change, sometimes within a
short space of time. This is why the person should always be assessed prior to
movement and if the status of the person is different from the recorded assessment,
then the assessment form should be amended.

When to Assess
As soon as possible after admission and thereafter when there is any change in the
person’s condition resulting in changes to the moving and handling.

Who to Assess
An individual assessment form should be used to assess the person or in some
areas, a generic risk assessments may be completed and recorded in the Manual
Handling Risk Assessment Folder (MHRAF).

Where to keep the Assessment Form

The form needs to be accessible to all personnel who may be involved in the moving
and handling of the person and its actual location may vary from one area to another.
The form should travel with the person when moving from one ward/department to
another e.g. people going to Medical Imaging etc.

To Determine the Level of Risk

A professional judgment has to be made based on the information ascertained. The
level of risk will depend on the handling factors present and the capabilities of the
person. As a person’s condition and capabilities may vary it can be difficult to classify
the level of risk into high medium or low.

However if a person requires any ‘hands on’ assistance, there is a potential risk to the
handler. Codes A (assistance) or U (unable) are used on the assessment form to
indicate this and because there is a manual handling risk, the patient movement plan
must be completed (Side 2 of the assessment form).

Manual Handling Risk Assessment People 2012 23

 Patient Handling Assessment Form Page One
This form can be found in the Combined Risk Screening and Assessment document.
Two versions are available – long stay (4 pages) and short stay (2 pages).

How To Complete The Form

The person’s name & address details should be recorded on the first page of the
document along with other basic details i.e. admission date, height and weight, BMI,
smoker/nonsmoker.

Complete other information: impaired hearing; sight

Complete assessment date and ward in relevant column

Handling Factors:
These are the factors which will influence the way the person moves or is moved. All
factors present must be identified by either putting a tick or comment in the box.

Unpredictable behaviour This will significantly increase the handling risks especially if the
person is violent or aggressive

Variable or non co-operation Indicate which.

Variable/ no comprehension Level of understanding will influence the handlers explanations

and commands

Pain Indicate the cause/site of pain if relevant

Pressure sore/wounds/at risk Indicate site or type of sore/wound or if none

present but person at risk state ‘at risk’

Type of mattress State type

Infusions/attachment to equipment If appropriate state attachment(s) e.g. catheter/drip etc.

Traction/splints etc. If a splint is worn intermittently state when worn e.g. night splint/
splint to mobilise etc.

Oedema State where

Patient for rehabilitation If yes, there may be an increased risk through encouraging the
person to do more for themself

Muscular spasm/rigidity If appropriate give details

Paralysis/weakness State where

Continence problems May affect use of equipment e.g. cleaning of hoist

slings/slidesheets etc.

History of falls: The person is a foreseeable risk of falling and ways of reducing
the risk must be addressed

Additional factors e.g. barrier nursing. This may affect e.g. use of equipment

Other State e.g. cultural influences

Mobility Factors Identify the person’s mobility levels
Insert the appropriate code* for each activity.

*Code
I = Independent. Person requires no assistance whatsoever

S = Supervision. Person requires verbal encouragement/physical presence of handler but no

assistance

A = Assistance. Person requires physical assistance of handler but able to help

U = Unable. Person requires assistance of handlers or hoist because unable to help.

If codes I and S have been identified for all activities, Page 2 of the assessment does
not need to be completed.

If codes A or U have been identified for one or more activities, Page 2 of the
assessment must be completed (relevant sections)

Assessors signature and designation

Ensure assessment is signed

Patient Handling Assessment Form Page Two

Patient Movement Plan
The information on this page indicates how the person can be moved safely and is
used for those people requiring assistance.

The date for each assessment should correspond with the dates on Page 1

Tick the appropriate box or fill in the information required. The number of handlers
required relates to the minimum number and should always be completed.

If a person is independent in certain activities this will be indicated on

the front sheet and those sections do not need to be completed on Page 2.

For example; a person may be able to move independently up the bed and across the bed, but needs
assistance with all activities out of bed.
The sections where assistance is not required would have N/A written through the assessment grid for
that assessment date.

When the assessment is complete, the assessor must sign it.

Reassess weekly and when there is a change in condition or situation (transfer of

ward).

Manual Handling Risk Assessment People 2012 25

 People Handling
Prevention of injury/lowering risks
The following, guidelines for minimising risk are common to most people handling
manoeuvres and should be taken into account before moving patients.
The Task
see also People Handling Guidelines for details of techniques of handling

General Guidelines all Techniques

• Encourage the person to move him/herself (consider use of handling aids)
• Get as close to person as possible
• Keep shoulders and pelvis in alignment (i.e. avoid twisting)
• Use approved techniques and handling aids
• Move the person in stages (short distances) not in one go.
• Choose the appropriate technique for the patient’s condition
• Take time to prepare and execute the manoeuvre.
• Bend at the knees (either in squat position or knee on bed) to eliminate stooping
• Prevent the person from sliding down in the chair or bed
• Ensure enough handlers are available

The Load (The Person)

• Ensure that a risk assessment is completed.
• Ensure that the weight of the person is recorded
• Ensure adequate assistance, especially for more difficult people and for those who
are attached to drips and other equipment.
• Where possible encourage the person to move for him/herself rather than
automatically offering assistance.
• Avoid lifting by using slidesheets, hoists, patslides and other aids

Working Environment
• Ensure adequate space in working area - move furniture if necessary.
• Remove obstacles i.e. pillows, loose clothing, earphones, call buzzers etc.
• Ensure spills are mopped up.
• Adjust bed to correct and comfortable working height.
• Ensure brakes are applied to bed, commode, trolley, wheelchair etc.
• Turn off portable fan until manoeuvre is executed.
• Ensure person’s clothing is not trapped and therefore restricting movement.
• If temperature is hot and/or humid, beware of fatigue plus sweaty hands which
might slip; can windows be opened?
• If the working environment is outside (for example assisting person into a car),
ensure adequate clothing on cold days for both person and handler.
The Individual
• Ensure that every member of staff is trained in approved handling techniques and
has knowledge of the basic principles of handling and risk assessment.
• Ensure that uniform allows freedom of movement and footwear fully encloses the
foot.
• Ensure that adequate help is available for more difficult people and for those
workers with health problems/existing injuries or for those who are pregnant.
• Ensure that all handlers use the handling aids provided i.e. hoists; slide sheets;
slide boards etc. These are designed to minimise or eliminate actual lifting of the
person and should be used whenever moving patients. (NB THIS IS A LEGAL
REQUIREMENT)
• All handlers should be aware of their own posture during patient handling tasks and
try to avoid the twisting and stooping postures, which can lead to injury.

Manual Handling Risk Assessment People 2012 27

 Movement of Loads
Reducing the risk of injury

Load handling assessments should be included in the MHRAF and specific action
identified. However with any load handling there are general guidelines, which can be
followed to reduce the risks of injury. These are outlined below.

The Task
• Ensure that the load is held as close to the trunk as possible.
• Ensure that heavy loads are stored at waist level.
• Where possible, avoid lifting loads (especially heavy loads) from floor level and
above shoulder level.
• Avoid stooping postures by bending at the knees.
• Avoid twisting postures (especially when lifting or transporting a load) by keeping
the body segments (upper and lower trunk) in alignment.
• If the load has to be carried long distances (over 10m without resting), use a
trolley and ensure that an upright posture is maintained whilst pushing it.
• It the task necessitates repetitive handling, try to either, vary the work (to allow one
set of muscles to rest while another set is used) or ensure adequate rest or
recovery breaks.
• If possible, replace lifting with controlled pushing or pulling i.e. slide the load along.

The Load
• In certain situations, the load can be packed into smaller containers to reduce the
weight and make it easier to manage.
• If the shape, texture or nature of the load makes it difficult to grasp, it may be
possible to place it into a container which is easier to handle.
• Ensure that the load is as stable as possible before moving it; extra packaging
may be required so that objects do not shift unexpectedly.
• Personal protective equipment or handling aids may be required if the load has
sharp edges or is potentially harmful to the handler.

The Working Environment

• Ensure adequate space in the working area; remove any obstructions.
• Ensure that any spills are mopped up and rubbish cleared away.
• Ensure good lighting
• If the temperature is hot/humid: beware of the faster approach of fatigue which
leads to a drop in muscular efficiency (and therefore a drop in handling capacity):
beware also of sweaty hands leading to loss of grasp.
• If the temperature is cold: beware of loss of dexterity in the hands - personal
protective equipment may be required.
• Extra care will be required if handling loads on an unstable or uneven surface, or
where there is a difference in levels.
The Individual

• Ensure that staff are trained and regularly updated in safe manual handling
techniques and have an underpinning knowledge of the relevant legislation, care
of the back and principles of handling.
• Ensure that staff are trained in the use of any manual handling equipment
available to them.
• Ensure that adequate help is available for the more difficult or awkward handling
tasks.
• Ensure that adequate help is available for those workers with health problems,
existing injuries or those who are pregnant.
• Ensure that staff use any handling equipment available to them.
• Ensure that clothing or personal protective equipment allows freedom of
movement and footwear fully encloses the foot.

Manual Handling Risk Assessment People 2012 29

 Identifying the Level of Risk

Choose the appropriate rating in the boxes below. To ascertain the level of risk,
multiply Consequence X Likelihood scores then refer to matrix for level of risk.

Quantitative measures of consequence:

If there was an incident what would be the most likely level of injury?

1 no obvious harm No injury. Minimal impact to organisation

2 Minor First-aid treatment. Moderate financial loss
3 Medium Medical treatment required Moderate environmental implications.
High financial loss. Moderate loss of reputation. Moderate
interruption of business
4 Serious Excessive injury. High environmental implications. Major financial
loss. Major loss of reputation. Major business interruption.
5 Dangerous Death

Quantitative measures of likelihood

If there was an incident what is the likelihood of it occurring?
1 Rare The event may occur but only in exceptional circumstances
2 Unlikely The event is unlikely to occur
3 Possible The event might occur at some time
4 Likely The event is likely to occur but not frequently
5 Almost certain The event will undoubtedly occur, possibly frequently

Risk Rating - multiply Consequence X Likelihood scores then refer to matrix for level of risk

QUANTITATIVE RISK ASSESSMENT MATRIX - LEVEL OF RISK

CONSEQUENCES PROBABILITY
Rare Unlikely Possible Likely Almost Certain
(1) (2) (3) (4) (5)
no obvious harm - 1 1 2 3 4 5
Minor - 2 2 4 6 8 10
Medium - 3 3 6 9 12 15
Serious - 4 4 8 12 16 20
Dangerous - 5 5 10 15 20 25

key low risk moderate risk significant risk high risk

Note: All risk assessments resulting in a risk rating of less than 8 (low – moderate) must be entered
onto the Directorate/Department Risk Register and managed within the Department.

Risk ratings of 8 to 12 (significant) will be managed by the Directorate/Department Governance

arrangements and appear on their Risk Register.

Any risk of 15 or above (high) must be forwarded to the risk office for entry onto the Corporate Risk
Register.
 BIBLIOGRAPHY

Lighten the Load. Health & Safety Executive package

The Manual Handling Operations Regulations 1992

SI 1992 No 2793 HMSO

The Management of Health and Safety at Work Regulations

S1 1992 No 2051 HMSO

Lloyd P.V. The Guide to the Handling of Patients 4th Edition(1997) Back Pain
Association

Smith J. (ed) (2005) The Guide to the Handling of People 5th Edition Back Care

Manual Handling Risk Assessment People 2012 31