The Activity Based Risk Assessment Form Mom is a crucial workplace safety document required under Australian health and safety legislation to protect pregnant employees and new mothers in the workplace. This form should be completed when an employee notifies their pregnancy, returns from maternity leave, or when their work circumstances change. It incorporates comprehensive risk evaluation methodology aligned with the Work Health and Safety Act 2011 (Cth) and state-specific regulations, ensuring that all potential hazards are identified and appropriate control measures are implemented. The assessment considers various factors including physical demands, workplace environment, ergonomic requirements, and specific job-related risks, while also accounting for different stages of pregnancy and post-partum needs. Regular reviews and updates are required to ensure continued effectiveness of control measures and compliance with safety standards.
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1. Assessment Details: Basic information including date, location, assessor name, and mother's details
2. Activity Description: Detailed description of the work activities being assessed
3. Current Stage: Identification of pregnancy stage or post-partum status to determine specific risk factors
4. Hazard Identification: Systematic listing of potential hazards associated with the activities
5. Risk Assessment Matrix: Standard risk matrix showing likelihood and consequence ratings
6. Initial Risk Rating: Assessment of risks before control measures are implemented
7. Control Measures: Specific measures to eliminate or minimize identified risks
8. Residual Risk Rating: Assessment of remaining risks after control measures are implemented
9. Monitoring Requirements: Schedule and methods for ongoing monitoring of implemented controls
10. Review and Sign-off: Approval section including signatures from assessor, mother, and supervisor
1. Medical Considerations: Section for specific medical conditions or requirements, to be included when there are special medical circumstances
2. Ergonomic Assessment: Detailed ergonomic evaluation, to be included for desk-based or repetitive physical tasks
3. Temperature and Environmental Conditions: Assessment of workplace environment, to be included for outdoor work or temperature-sensitive environments
4. Chemical Exposure Assessment: Detailed assessment of chemical risks, to be included when work involves potential exposure to hazardous substances
5. Emergency Response Procedures: Specific emergency procedures, to be included for high-risk work environments
6. Breastfeeding Facilities Assessment: Evaluation of facilities and breaks needed, to be included for nursing mothers
1. Appendix A: Risk Matrix Guide: Detailed guide for using the risk assessment matrix
2. Appendix B: Hazard Checklist: Comprehensive checklist of potential hazards specific to pregnant and nursing mothers
3. Appendix C: Control Measures Library: Reference list of standard control measures for common risks
4. Appendix D: Relevant Legislation: Summary of applicable workplace health and safety legislation
5. Appendix E: Emergency Contacts: List of relevant emergency and medical contacts
6. Schedule 1: Review Timeline: Schedule for periodic reviews and updates of the risk assessment
7. Schedule 2: Monitoring Checklist: Checklist for regular monitoring of control measures
Relevant legal definitions
Activity
Assessment Date
Assessor
Control Measures
Consequence
Duty of Care
Ergonomic Risk
Hazard
Hierarchy of Controls
Likelihood
Line Manager
Manual Handling
Maternity Period
Monitor
New and Expectant Mother
Nursing Mother
Occupational Health Provider
Personal Protective Equipment (PPE)
Post-partum Period
Pregnancy Stages
Reasonably Practicable
Residual Risk
Risk
Risk Assessment
Risk Control
Risk Level
Risk Matrix
Risk Rating
Safe System of Work
Safety Data Sheet
Suitable Work
Task Rotation
Workplace
Assessment Date
Assessor
Control Measures
Consequence
Duty of Care
Ergonomic Risk
Hazard
Hierarchy of Controls
Likelihood
Line Manager
Manual Handling
Maternity Period
Monitor
New and Expectant Mother
Nursing Mother
Occupational Health Provider
Personal Protective Equipment (PPE)
Post-partum Period
Pregnancy Stages
Reasonably Practicable
Residual Risk
Risk
Risk Assessment
Risk Control
Risk Level
Risk Matrix
Risk Rating
Safe System of Work
Safety Data Sheet
Suitable Work
Task Rotation
Workplace
Clauses
Assessment Details
Risk Identification
Hazard Assessment
Control Measures
Health and Safety
Medical Information
Workplace Modifications
Emergency Procedures
Review and Monitoring
Consultation
Confidentiality
Reporting Requirements
Implementation Timeline
Compliance
Documentation
Training Requirements
Support Measures
Environmental Conditions
Equipment and Resources
Communication Protocol
Risk Identification
Hazard Assessment
Control Measures
Health and Safety
Medical Information
Workplace Modifications
Emergency Procedures
Review and Monitoring
Consultation
Confidentiality
Reporting Requirements
Implementation Timeline
Compliance
Documentation
Training Requirements
Support Measures
Environmental Conditions
Equipment and Resources
Communication Protocol
Relevant Industries
Healthcare
Education
Professional Services
Retail
Manufacturing
Hospitality
Government and Public Sector
Construction
Mining
Information Technology
Financial Services
Transport and Logistics
Agriculture
Scientific Research
Media and Communications
Relevant Teams
Human Resources
Workplace Health and Safety
Occupational Health
Risk Management
Operations
Facilities Management
Legal and Compliance
Industrial Relations
Employee Relations
Medical Services
Relevant Roles
Workplace Health and Safety Manager
Human Resources Director
Occupational Health Nurse
Risk Assessment Specialist
Health and Safety Coordinator
HR Business Partner
Operations Manager
Facility Manager
Department Supervisor
Safety Compliance Officer
Employee Relations Manager
Occupational Health and Safety Consultant
Return to Work Coordinator
Industrial Relations Manager
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