Individual Staff Risk Assessment & Deployment Constraints (HR-F023) INDIVIDUAL STAFF RISK ASSESSMENT (HR-F023) Updates INDIVIDUAL STAFF RISK ASSESSMENT Individual Staff Risk Assessment & Deployment Constraints (HR-F023)SECTION 1: ASSESSMENT BASELINE & TRIGGERTitle- Select -MrMrsMissMsMxOtherStaff Member NameStaff_IDOperating Local Authority- Select -HaringeyIslingtonBarnetWaltham ForestCamdenHackneyBrentHarrowRedbridgeNewhamCity of LondonWestminsterTower HamletsBarking and DagenhamHaveringKensington and ChelseaHammersmith and FulhamEalingHillingdonHounslowSouthwarkLambethLewishamGreenwichWandsworthRichmond upon ThamesMertonKingston upon ThamesSuttonBexleyBromleyCroydonOtherExternal Medical Advice Provided- Select -GP Fit NoteOccupational Health ReportMAT B1 FormNoneN/AExact clinical restrictions advised- Select -No heavy lifting, hoisting, or physical load-bearing.Restricted to light duties only (prompting, companionship, basic assistance).Strict limits on working hours (e.g., phased return, restricted shift lengths, no waking nights).Restricted from prolonged standing, extensive walking, or prolonged driving.Avoidance of specific hazardous environments, chemicals, or infectious risks.Temporary redeployment to non-clinical, administrative, or office duties strictly advised.No specific restrictions documented; general health monitoring advised.Not Applicable (No external medical advice provided).SECTION 2: DOMICILIARY HAZARD IDENTIFICATION, EVALUATION & MANDATORY CONTROL MEASURESManual Handling & Ergonomics (Safe QS6): Does the employee's condition (e.g., pregnancy, historic back injury, severe menopausal joint pain) increase their risk of musculoskeletal harm when operating hoists or standing continuously?- Select -YesNoN/APre-Mitigation Risk- Select -LowMediumHighLone Working & Psychological Maturity (Safe QS5): Is the employee specifically vulnerable while working alone? (e.g., Young worker lacking psychological maturity for end-of-life care, or a staff member with severe anxiety post-incident).- Select -YesNoN/APre-Mitigation Risk- Select -LowMediumHighInfection Prevention, COSHH & Medication (Safe QS4 & QS7): Is the employee immunocompromised, or are they an expectant/nursing mother at risk from biological hazards (e.g., COVID-19, bodily fluids) or chemical hazards (e.g., exposure to crushed teratogenic/cytotoxic medications or strong cleaning agents)?- Select -YesNoN/APre-Mitigation Risk- Select -LowMediumHighWorking Hours, Night Work & Fatigue (Well-led QS2): Does the condition limit the ability to work long hours or waking nights? (e.g., pregnant workers are legally protected from forced night work; young workers have strict WTD limits; menopausal insomnia impacts fatigue).- Select -YesNoN/APre-Mitigation Risk- Select -LowMediumHighDriving, Travel & Temperature (Safe QS5): Is the employee's ability to drive impaired by medication/fatigue, or do they require specific environmental temperature controls (e.g., due to pregnancy or menopause hot flushes)?- Select -YesNoN/APre-Mitigation Risk- Select -LowMediumHighRostering / Deployment Constraints (Select all applied)No Manual HandlingNo Lone WorkingIPC / COSHH FilterTime & Night CapComplex/End-of-Life BlockRest Break MandateAdditional Reasonable Adjustments Provided- Select -None RequiredPhysical/ErgonomicEnvironmental/TravelSchedulingRedeploymentPsychological/WellbeingSECTION 3: RESIDUAL RISK , ACTION PLAN, MONITORING, REVIEW & SIGN-OFFAssessor's Residual Risk Grading (Post-Mitigation)- Select -Low - Mitigations are effective; safe to deploy within agreed constraints.Medium - Mitigations in place, but requires close monitoring and bi-weekly review.High - Even with mitigations, the role poses an unacceptable risk to the employee's health or statutory law.What is the immediate legal action?- Select -Suspend on medical/maternity grounds (Full pay required for pregnancy-related suspensions).Temporary redeployment to office/administrative duties (DSE Assessment Required).N/A - Risk is Low/MediumEmployee Declaration- Select -I confirm I have been consulted during this assessment. I agree to abide by the constraints listed above and will immediately inform my manager if my medical condition changes, if I am prescribed new medication, or if I feel unsafe.Registered Manager Authorization- Select -I confirm these constraints adhere to the Equality Act 2010 and the MHSWR 1999. They have been directly communicated to the Care Coordination team and hardcoded into the rostering system.DateNext Review Date:SUBMIT FORM
