New and Expectant Mothers Checklist

Employee Name_____________________

Employee Job Title___________________

Yes

No

Comments

Medical Certificate Received

Does the task involved:

Yes

No

Continuous standing

Continuous sitting

Any work in confined spaces

Manual Handling

Any shocks or vibration

Ionisation radiation

High pressure

Stress

Chemical agents

Biological agents

Passive smoking

Excessive travelling

Extreme heat or cold

Working at heights

Work related violence

Working alone

Working with display screen equipment

Are additional risk assessments required

Completed by:

Date

Any yes answers to the tasks below will require a risk assessment