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1. Employee Information: Details of the employee, including name, position, department, and relevant dates (due date/return to work date)
2. Stage of Pregnancy/Maternity: Indication of whether the assessment is for early pregnancy, late pregnancy, returning mother, or breastfeeding mother
3. Work Activities Assessment: Detailed review of regular work activities and associated risks
4. Physical Hazards Assessment: Evaluation of physical workplace hazards including manual handling, posture, movements, and workstation setup
5. Environmental Hazards Assessment: Assessment of workplace environment including temperature, noise, lighting, and ventilation
6. Chemical Exposure Assessment: Identification and evaluation of potential exposure to harmful substances
7. Control Measures: Specific actions and adjustments to be implemented to minimize identified risks
8. Review Schedule: Timeline for regular reviews and updates of the assessment
1. Night Work Assessment: Additional assessment for employees working night shifts or irregular hours
2. Laboratory/Clinical Environment Assessment: Specific hazard assessment for employees working in laboratory or clinical settings
3. Remote Work Assessment: Evaluation of risks associated with working from home or remote locations
4. Travel Requirements Assessment: Assessment of work-related travel risks and necessary adjustments
5. Emergency Procedures: Special considerations for emergency evacuation and response procedures
1. Schedule A: Risk Matrix: Standard risk assessment matrix for evaluating likelihood and severity of risks
2. Schedule B: Workplace Adjustment Checklist: Detailed checklist of potential workplace adjustments and accommodations
3. Schedule C: Medical Information Form: Template for recording relevant medical advice and restrictions
4. Appendix 1: Legal Requirements Reference: Summary of relevant legislation and employer obligations
5. Appendix 2: Hazardous Substances Register: List of workplace substances that may pose risks during pregnancy or breastfeeding
Expectant Mother
Pregnancy
Risk Assessment
Hazard
Control Measure
Reasonably Practicable
Safe System of Work
Manual Handling
Display Screen Equipment
Biological Agent
Chemical Agent
Physical Agent
Night Work
Breastfeeding Mother
Personal Protective Equipment (PPE)
Work Area
Workplace Adjustment
Risk Level
PCBU (Person Conducting a Business
Due Date
Return to Work Date
Review Date
Safe Job
Alternative Duties
Occupational Exposure Limit
Medical Certificate
Rest Facilities
First Trimester
Second Trimester
Third Trimester
Post-natal Period
Risk Matrix
Significant Risk
Working Conditions
Medical Information
Risk Identification
Physical Hazards
Chemical Hazards
Biological Hazards
Working Conditions
Manual Handling
Workplace Adjustments
Emergency Procedures
Review and Monitoring
Control Measures
Consultation Process
Privacy and Confidentiality
Medical Certification
Rest and Facilities
Work Schedule Modifications
Travel Requirements
Personal Protective Equipment
Documentation Requirements
Reporting Procedures
Communication Protocol
Implementation Timeline
Assessment Review
Return to Work
Healthcare and Medical Services
Education and Childcare
Manufacturing and Industrial
Retail and Hospitality
Professional Services
Construction
Laboratory and Research
Transportation and Logistics
Mining and Resources
Public Sector and Government
Chemical and Pharmaceutical
Human Resources
Workplace Health and Safety
Risk and Compliance
Occupational Health
People and Culture
Employee Relations
Operations Management
Medical Services
Legal and Compliance
Human Resources Manager
Workplace Health and Safety Manager
Risk Assessment Officer
Occupational Health Nurse
HR Business Partner
Health and Safety Representative
Return to Work Coordinator
Employee Relations Manager
Workplace Safety Officer
Line Manager
Department Supervisor
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