The Activity Based Risk Assessment Form Mom is a crucial workplace safety document required under Canadian occupational health and safety regulations to protect pregnant and nursing mothers in the workplace. This assessment must be completed when an employee informs their employer of pregnancy or nursing status, or when there are significant changes to workplace conditions or the employee's health status. The form facilitates a comprehensive evaluation of workplace activities, potential hazards, and necessary accommodations in accordance with federal and provincial safety standards. It includes detailed risk assessments, control measures, and action plans, ensuring compliance with the Canada Labour Code and related provincial legislation while protecting both the mother and child's health and safety. The document serves as a legal record of risk assessment and implemented control measures, and may be required for workplace insurance or accommodation purposes.
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1. Assessment Information: Basic details including date, location, assessor name, and mother's information
2. Activity Description: Detailed description of the work activities being assessed
3. Current Stage of Pregnancy/Nursing: Information about the pregnancy trimester or nursing status to properly evaluate risks
4. Hazard Identification: List of potential hazards associated with the activity
5. Risk Evaluation: Assessment of likelihood and severity of identified risks
6. Current Control Measures: Existing safety measures and protocols in place
7. Additional Control Measures Required: New or modified controls needed to ensure safety
8. Action Plan: Specific steps to implement additional control measures, including timelines and responsibilities
9. Sign-off: Signatures from the assessor, mother, supervisor, and occupational health representative
1. Ergonomic Assessment: Detailed evaluation of physical movements and postures, particularly relevant for activities involving manual handling
2. Chemical Exposure Assessment: Required when work involves potential exposure to chemicals or hazardous substances
3. Environmental Factors: Assessment of temperature, noise, vibration, and other environmental conditions when relevant to the workplace
4. Emergency Procedures: Specific emergency protocols for pregnant/nursing mothers, added when working in high-risk environments
5. Medical Recommendations: Section for occupational health physician's specific recommendations when medical input is required
1. Appendix A - Hazard Checklist: Comprehensive checklist of common workplace hazards relevant to pregnant and nursing mothers
2. Appendix B - Risk Matrix: Standard risk assessment matrix for evaluating likelihood and severity of risks
3. Appendix C - Control Measure Guidelines: Reference guide for recommended control measures for common hazards
4. Appendix D - Relevant Legislation: Summary of applicable health and safety legislation and guidelines
5. Appendix E - Emergency Contact Information: List of relevant emergency contacts and procedures
Authors
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Education
Manufacturing
Retail
Office and Administrative
Laboratory and Research
Food Service
Hospitality
Construction
Transportation
Chemical Industry
Pharmaceutical
Public Service
Mining
Agriculture
Relevant Teams
Occupational Health and Safety
Human Resources
Risk Management
Environmental Health
Employee Relations
Medical Services
Operations
Industrial Hygiene
Facilities Management
Legal
Relevant Roles
Occupational Health and Safety Manager
Human Resources Manager
Risk Assessment Specialist
Workplace Safety Coordinator
Occupational Health Nurse
Health and Safety Officer
Environmental Health and Safety Specialist
Industrial Hygienist
Ergonomist
Department Supervisor
Union Safety Representative
Occupational Health Physician
Employee Relations Manager
Workplace Accommodation Specialist
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