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This is a Risk Assessment form we have (skillsforcare)

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Page | 1
Version 1.0
This is a Risk Assessment form we have adapted from NHS Foundation for managers to use with team
members
Covid-19 Personal Risk Assessment Process
This process should be used to help managers and staff hold a constructive discussion to consider
adjustments or redeployment for any staff that are identified as being at greater risk.
This assessment is not for staff who fulfil the government criteria for ‘Shielding’ – these staff should
follow national guidance and stay at home.
Process:
• The manager or responsible clinician should provide Section 1: Personal Risk Assessment Matrix
to each member of staff
• Staff member completes Section 1 and returns to manager/clinician
• Where self assessment includes one or more of the following, prioritise a meeting with the
member of staff to discusss implications and take appropriate measures to mitigate the risk of
Covid-19 infection:
o high risk
o very high risk
o BAME
o pregnant
o where the staff member is low risk but requests a priority meeting
Note: meet with all other members of staff to complete Section 5: Record of Discussion only,
during your next 1;1 / Supervision Session
• Use Section 2: Decision Tree to guide the discussion, reviewing the role/tasks of the staff
member in conjunction with the workplace risk assessment (Complete Section 3: Workplace
Risk Assessment if one doesn’t already exist)
• Use Section 4: Risk Avoidance/Mitigation Guidance (as at May 2020) to identify appropriate
adjustments consistent with self-assessment outcome and workplace risk level
• Discuss general wellbeing with staff member. The manager should seek to understand any
home/work circumstances which may impact or influence the individual’s risk threshold.
Through open ended questioning such as ‘how can I help?’ further support may be identified,
and may include referral to Occupational Health, Care First telephone support, and Trust
Wellbeing resources
• Additionally, ensure staff are familiar with the following:
o Local infection control and PPE arrangements
o Social distancing both during work and during breaks
o Arrangements for reporting illness, including symptoms of COVID-19 infection
o COVID-19 swab testing arrangements for self/family members
o Any recent changes in practice, policies and adaptations to the work environment
• Record and sign-off the discussion in Section 5: Record of Review
• Staff member and manager/clinician should retain a copy
Page | 2
Version 1.0
Section 1: Personal Risk Assessment Matrix
Staff Name:
RISK FACTOR
Points
Risk Factor
Score
Age
50-59
1
60-69
2
70+
7
Sex at birth
Female
0
Male
1
Underlying
Health
Conditions
Cardiovascular disease (on treatment for hypertension,
irregular heartbeat, heart failure, previous heart attack, stroke,
TIA etc)
1
Diabetes Mellitus Type 1 or 2
1
Chronic pulmonary disease (including asthma, COPD, interstitial
lung disease)
1
Chronic kidney disease (any stage 1-5)
1
Sickle cell/Thalassaemia trait or other haemoglobinopathies
1
Obesity: BMI >30 or waist circumference >33” (BAME female);
> 34.5” (white female); >35” (BAME male);
40+” (white male)
1
Ethnicity
BAME or Mixed race
1
Other
Has any member of your immediate family died from or been
in ITU due to Covid19 ?
1
TOTAL
Sources:British Association of Physicians of Indian Origin; Risk Reduction Framework for NHS Staff at risk of COVID-19 infection
Ethnicity
Pregnancy
Meeting
Request
I am low risk, however request a priority meeting
Prioritise a meeting to discuss implications and take appropriate
measures to mitigate the risk of Covid-19 infection
Hold a wellbeing discussion
as part of your next 1:1 or
supervision meeting
Mild Risk
Score 0-3
High Risk
Score 4 – 6
Very High Risk
Score 7+
BAME and/or
Pregnancy/or requests
a meeting
Page | 3
Version 1.0
Section 2: Decision Tree for Managing Staff at Increased Risk of Severe Illness from COVID-19
No
Does the workplace assessment
identify adjustments which should be
made for medium and high risk staff?
Can hazard be avoided or risk reduced
to acceptable level?
Yes
Risk of severe illness
(or risk to family) as
determined by
Occupational
Health/GP/NHS letter
or Personal Self-
Assessment
Yes
Does a workplace risk
assessment already
exist for the work area?
Yes
No
No further action
required
No
Yes
No
Are further adjustments possible
reduces risk to an acceptable limit?
e.g. home working
Absence will be authorised and taken as
annual leave or unpaid leave (see ‘Taking
Time Out during Covid’ for options).
Seek Deputy/HRBP advice if necessary)
Make adjustments in
line with risk
assessment
Does staff member agree that the
risk assessment reduces the risk to
an acceptable limit?
No
Absence will be authorised and
taken as medical suspension (seek
Deputy/HRBP advice if necessary)
Start Here
No
Undertake a workplace risk assessment - see
Section 3 (or seek guidance from suitably
qualified staff).
Use workplace risk assessment to consider
reasonable adjustments for medium and high
risk staff.
Guidance can be found here:
• HR FAQ
• Pregnant Women
• Trust RISK ASSESSMENT INFORMATION
• Section 4: Risk Avoidance/Mitigation
Guidance
Is this supported by a
fit note/NHS letter for
personal self-isolation
for 12 weeks?
Yes
Yes
No
Absence will be
authorised and
recorded as medical
suspension
No
No
Yes
Can arrangements be
put in place to work
from home?
Yes
Page | 4
Version 1.0
Section 3: Workplace Assessment
Green
Work assessed as
COVID-19 low risk
Amber
Medium risk
Environment / working practices may
need to be tailored for individuals to
lower identified areas of risk.
Red
High risk
Create an action plan to identify and address causes.
This could include individual assessments or specific
working arrangements.
Relevant Guidance:
• Working in Care Homes - https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-care-homes
• Working in Homecare - https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-domiciliary-care
• Supporting Adults with Learning Disability and Autism - https://www.gov.uk/government/publications/covid-19-supporting-adults-with-learning-
disabilities-and-autistic-adults
Working Environment
Level of interface with potentially infected Patients:
Additional controls to be
established:
• Working with known or suspected COVID-19 infected – Red/High
• Working with Patients – Amber/Medium
• Public-Facing – Amber/Medium
• Office-Based – Green/Low
Washing Facilities
Additional controls to be
established:
• Hand washing facilities with soap and hot water at a reasonable distance in place
• Stringent hand washing taking place in line with Infection Control Policy and national guidance
• Paper towels/hand dyers available for drying of hands
• Gel sanitisers in areas where washing facilities are not readily available
See internal guidance and/or training
Page | 5
Version 1.0
See NHS hand washing guidance
Social Distancing
Additional controls to be
established:
• The number of persons in any work area complies with the 2-metre (6.5 foot) gap recommended by Public Health
England see Social Distancing – Gov.UK ;
Cleaning of Environment
Additional controls to be
established:
• Frequent cleaning and disinfecting objects and surfaces that are touched regularly particularly in areas of high use such
as door handles, light switches using appropriate cleaning products and methods.
Personal Protective Equipment (PPE)
Additional controls to be
established:
• Public Health guidance on the use of PPE to protect against COVID-19 to be maintained.
• In all other settings individuals are asked to observe social distancing measures and practice good hand hygiene
behaviours.
• Where Risk Assessment identifies wearing of gloves/PPE as a requirement of the job, an adequate supply of these will
be provided. Staff will be instructed on how to remove gloves/PPE carefully to reduce contamination and how to
dispose of them safely
Respiratory Protective Equipment (RPE)
Additional controls to be
established:
• Tight-fitting face pieces (such as disposable FFP3 masks) rely on having a good seal with the wearer’s face. Where tight
fitting face pieces are a requirement a fit test will be carried out to ensure the RPE can protect the wearer
Are there other factors that need to be taken into account?
•
•
Additional controls to be
established:
Page | 6
Version 1.0
Overall Risk Rating: please identify (tick or X in shaded box)
Green (low risk) = e.g. mostly green, one or two rated as amber
Amber (medium risk) = e.g. single red and / or small number of ambers
Red (high risk) = e.g. two or more red ratings in assessment
Page | 7
Version 1.0
Section 4: Risk Avoidance/Mitigation Guidance (as at May 2020)
Personal
Risk Rating
Guidance
Considerations for all Staff Groups
Mild
(0-3)
• Continue working as normal, following infection control and
safety precautions applicable to role and work area
• Availability and accessibility of relevant level of PPE
• PPE Fit-test complete (where appropriate)
• Training in use of PPE complete (refresher required?)
• Workplace social distancing measures (e.g. barriers in
front of reception areas, use of less frequented offices to
ensure 2 metres between employees, arrangements for
breaks, break-out areas)
• Alternative ways of delivering role eg. telephone/video
• Alternative working patterns eg. rota system to reduce
contact time such as alternate weeks on-site
• Travel to work arrangements eg. avoiding public
transport/rush hour through adjustments to work hours
• Reduce contact with general public
• Alternative access/routes into the hospital to reduce
contact with general public
• Limiting duration of close interaction with the patient (for
example, preparing everything in advance away from
them)
• If possible, maintaining a two-metre distance from the
patient
Wellbeing
• Signposting to Wellbeing resources including Employee
Assistance Programme (Care First) and Avon Partnership
Occupational Health
• Arrange regular wellbeing check-ins
• Ensure staff member takes regular annual leave
High Risk
(4-6)
• Avoid high-risk procedures (e.g. aerosol generating procedures,
Covid-19 swabbing)
• Work from home where possible
• Minimise face-to-face patient contact
• Staff who attend work should do so in a low-risk environment
and follow infection control and safety precautions applicable
to low-risk work area
• Work in a separate room where possible
• Consider adjusting working hours where possible to limit
exposure (eg reduced shift length)
Very High
Risk
(7+)
• Remove from frontline duties and work from home where
possible
• Staff should not work in a patient-facing role
• Staff who attend work should do so in a low-risk environment
and follow infection control and safety precautions applicable
to low-risk work area
• Where possible work in a separate office with minimal
movement within the building
Page | 8
Version 1.0
Section 5: Record of Review
Employee Name:
Service
Manager Name:
Date of discussion:
Personal Risk Assessment Rating:
Mild / High / Very High
Use Section 2: Decision Tree to guide the
discussion, reviewing the role/tasks of the staff
member in conjunction with the workplace risk
assessment; agree and document appropriate
adjustments to mitigate/reduce risk.
Identify anything not agreed, and reasons for the
decision.
Wellbeing: any home/work circumstances which
may impact or influence the individual’s risk
threshold. Identify further support including
referral to Occupational Health, Care First, Trust
Wellbeing resources. Ensure staff are familiar with
• Local infection control and PPE arrangements
• Social distancing: during work and breaks
• Arrangements for reporting illness, including
symptoms of COVID-19 infection
• COVID-19 swab testing for self/family members
• Any recent changes in practice, policies and
adaptations to work environment
Sign off and each retain copy
Employee:
Manager:
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Completed 9 February 2021

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