RA PRocedure123

Public - To be published on the Trust external website
Risk Assessment (H&S) Procedure
Ref: HS-0001-017-v2
Status: Approved
Document type: Procedure
Overarching policy: Health and Safety Policy
Ref: HS-0001-017-v2 Page 1 of 26 Ratified date: 02 April 2024

Risk Assessment (H&S) Procedure Last amended: 02 April 2024
Contents
1 Introduction ............................................................................................. 3
2 Purpose .................................................................................................... 3
3 Who this procedure applies to ............................................................... 3
4 Related documents ................................................................................. 3
5 Procedure................................................................................................. 4
5.1 Plan, Do, Check, Act ................................................................................. 5
5.2 Methodology .............................................................................................. 6
5.3 Reviewing Control Measures and Risk Assessments ............................... 6
5.4 Reasonably Practicable ............................................................................. 7
5.5 Suitable and Sufficient ............................................................................... 7
5.6 Hierarchy of Control .................................................................................. 8
5.7 Risk Matrix................................................................................................. 8
6 Health, Safety and Security Team .......................................................... 8
7 Definitions ................................................................................................ 9
8 How this procedure will be implemented .............................................. 9
8.1 Training needs analysis .............................................................................. 10
9 How the implementation of this procedure will be monitored .......... 11
10 References ............................................................................................. 11
11 Document control (external)................................................................. 12
Appendix 1 – Risk Assessment Form ............................................................... 14
Appendix 2 – Further Information on the 5 Steps to Risk Assessment ............. 18
Appendix 3 – Risk Assessment Top Tips.......................................................... 20
Appendix 4 – Is Your Risk Assessment Suitable and Sufficient? Checklist ...... 21
Appendix 5 - Equality Analysis Screening Form ............................................... 22
Appendix 6 – Approval checklist ....................................................................... 25

1 Introduction
The Trust has a legal and moral obligation to manage risk. By following this procedure responsible
persons will ensure that the health and safety risks are adequately controlled.
This procedure links to Our Journey To Change as outlined within the Health and Safety Policy.
Note:
This procedure does not cover arrangements for organisational risk management in the Trust.
This is set out in the Organisational Risk Management Policy)
This policy does not cover the assessment and management of clinical risks relating to individual
service users. This is set out in the Harm Minimisation (Clinical Risk Assessment and
Management) Policy
2 Purpose
Following this procedure will help the Trust to comply with its legal obligations:
• Health and Safety at Work etc. Act 1974
• Management of Health and Safety at Work Regulations 1999
3 Who this procedure applies to
This procedure applies to all bank, locum, permanent, fixed term contract employees (including
apprentices) who hold a contract of employment or are engaged with the Trust, and seconded
(including students), volunteers, non-Executive Directors, Governors, and those undertaking
research work within TEWV Trust. It also applies to external contractors, agency workers, including
those within the GIG economy, limb workers, those on honorary contracts, those on work
experience and other workers who are assigned to TEWV Trust.
4 Related documents
This procedure describes what you need to do to implement duties under the Trust Health and
Safety Policy.
This procedure also refers to:
 Organisational Risk Management Policy

5 Procedure
Managers need to:
• Identify the risks the team are exposed to.

• List the risks in order of priority.
• Carry out detailed risk assessments for your area ensuring you capture all hazards present.
Examples of these are:
o Violence and Aggression.
o Lone Working.
o Control of Substances Hazardous to Health.
o Manual Handling of Objects.
o Manual Handling of Patients.
o Slip, Trips and Falls.
o New and Expectant Mothers/People.
o Display Screen Equipment.
o Wellbeing (Stress).
Please note that this list is not comprehensive.
• Involve and communicate risk assessment findings to all appropriate staff.
• Monitor the effectiveness of control measures.
• Ensure that they consider the following: “Some workers have particular requirements, for
example young workers, migrant workers new or expectant mothers and people with
disabilities.” HSE Website: Risk assessment: Steps needed to manage risk – HSE.
• Ensure that staff groups and individuals identified as being at risk are provided with appropriate
information, instruction, and training (including training at induction), updates and refresher
training as necessary.
• Ensure that risk assessments are reviewed on a regular basis e.g., after legislative changes,
after guidance changes, if control measures are ineffective, after an incident or if the
task/person has changed etc.
• Ensure that if you are unable to manage the risks presented that these are escalated
appropriately, documented on the risk assessment and evidence retained.

5.1 Plan, Do, Check, Act
Risk Assessments are a fundamental part of a health and safety management system. The Trust
utilises the Health and Safety Executive (HSE) HSG65, Plan, Do, Check, Act model as its Health
and Safety Management System to ensure compliance.
Risk assessment falls under the ‘Do’ section of ‘Plan, Do, Check, Act’. The HSE gives the following
advice:
• “Identify your risk profile:

o Assess the risks, identify what could cause harm in the workplace, who it could
harm and how, and what you will do to manage the risk
o Decide what the priorities are and identify the biggest risk.” HSE Website: Plan, Do,
Check, Act summary - Managing health and safety – HSE
The Plan, Do, Check, Act cycle - Reference HSG65

5.2 Methodology
The objective of risk assessment is to reduce and/or eliminate the consequence of a risk being
realised thereby reducing accidents, harm, loss, or disruption to services.
Effective risk assessment is based on a series of steps:

• Step 1 – Identify the hazards.
• Step 2 – Decide who might be harmed and how.
• Step 3 – Evaluate the risks and decide on precautions.
• Step 4 – Record your findings and implement them.
• Step 5 – Review your assessment and update if necessary.
Further information on the 5 steps to risk assessment can be found in Appendix 2.
Risk assessments:
• Should be documented on the form contained in Appendix 1 Risk Assessment Form.
• Should be rated.
• Should be undertaken by competent people.
• Should consider all groups that could be affected e.g., staff, contractors’ visitors, patients,
housekeeping staff, estates staff etc.
• Should consider all aspects of the work, including maintenance and cleaning.
• Should be held locally.
• Should be reviewed on a regular basis.
Top tips on risk assessment can be found in Appendix 3.
5.3 Reviewing Control Measures and Risk Assessments
You must review the risk assessments and control measures you have put in place to make sure
they are working.
You should also review them if:

• There are changes in legislation.
• There are changes in guidance.
• There has been an incident.
• They may no longer be effective.
• There are changes in the workplace that could lead to new risks such as changes to:
o Staff.
o A process / task / activity.
o The substances or equipment used.
• Problems are picked up during supervision or feedback has been given by staff.
Planned reviews can also be undertaken.
Update your risk assessment and record any changes you make.

5.4 Reasonably Practicable
“You're not expected to eliminate all risks, but you need to do everything 'reasonably practicable' to
protect people from harm. This means balancing the level of risk against the measures needed to
control the real risk in terms of money, time, or trouble.” HSE Website Risk Assessment: Steps
needed to manage risk.
This should be taking into consideration when undertaking/reviewing your risk assessments.
5.5 Suitable and Sufficient
The law states that a risk assessment must be ‘suitable and sufficient’, i.e., it should show that:
• A proper check was made.
• It states who might be affected.
• All the obvious significant risks are dealt with.
• It considers the number of people who could be harmed and how.
• The precautions/mitigations/control measures are reasonable.
• The remaining risk is low.
• Workers or their representatives were involved in the process.
Please note that the level of detail in a risk assessment should be proportionate to the risk and
appropriate to the nature of the work.
A checklist to determine if your risk assessment is suitable and sufficient is available in Appendix
4.

5.6 Hierarchy of Control
Effective health and safety is the robust management of risk.
Risk mitigation must employ the hierarchy of control, and this should be used when undertaking a
risk assessment. Please refer to the diagram shown below:
Most
Effective Elimination
Substitution
Engineering Controls
Administrative
Controls
Least PPE / RPE

Effective
The hierarchy of control uses a systematic approach:

• Elimination
o The risk no longer exists.
• Substitution
o Replacing the material or process for a less hazardous one.
• Engineering controls
o Use of equipment, physical barriers, screens, ventilation etc. Giving priority to
measures which protect collectively over individual measures.
• Administrative controls
o These are policies, procedures, signage etc.
• Personal Protective Equipment (PPE)
o Should be employed after all other measures have been considered.
5.7 Risk Matrix
A risk matrix tool is used to prioritise and evaluate the level of risk. This is detailed within Appendix
1.
6 Health, Safety and Security Team
The Health, Safety and Security Team (which also includes a Local Security Management
Specialist) provides advice and support to all staff and managers around the management of risk.

7 Definitions
Term Definition
Hazard • A hazard is a potential source of harm or adverse
health effect on a person.
Risk • The likelihood that a person may be harmed or

suffer adverse health effects if exposed to a hazard.
• The extent of the risk will depend on:
a) the likelihood of that harm occurring
b) the potential severity of that harm, i.e., of any
resultant injury or adverse health effect; and
c) the population which might be affected by the
hazard, i.e., the number of people who might be
exposed
Severity • The potential severity of the risk being realised.
Likelihood • How likely the risk event might happen.
Risk Rating • The risk rating is derived from the likelihood score
multiplied by the severity score Appendix 1 Risk
Assessment Form).
Risk Reduction • The process by which the risk is managed to reduce

the severity and/or likelihood of the occurrence of
the event.
Risk Assessment • Is a systematic evaluation of a work task or facility to

identify hazards and evaluate their likelihood to
cause harm in all foreseeable situations.
Risk Management • Is the process of deciding what to do when the risks

are identified, the implementation of the agreed
actions and the monitoring of the risk assessment
process.
Control Measures • Mitigations in place to reduce risk.
8 How this procedure will be implemented
• This procedure will be published on the Trust’s intranet.

• Line managers will disseminate this procedure to all Trust employees through a line
management briefing.
• Line managers to ensure that the appropriate staff are booked on to the courses identified in
the below training needs analysis and the examination (where applicable) is successfully
completed.
8.1 Training needs analysis
Staff/Professional Type of Training Duration Frequency of Training

Group
All staff Risk Assessment 1 hour 2 yearly

Awareness
(Toolkit and Risk
Assessment workshop)
Supervisors and Risk Assessment 1 day 2 yearly

Managers Training.

9 How the implementation of this procedure will be monitored
Number Auditable Standard/Key Frequency/Method/Person Where results and any

Performance Indicators Responsible Associate Action Plan will
be reported to, implemented
and monitored; (this will
usually be via the relevant
Governance Group).
1 Compliance with the legal Frequency: Annual rolling Implementation and monitoring
requirements outlined within audit programme. are directed by the Executive
the Management of Health Risk Group and devolved to
and Safety at Work Method: Risk Assessment the HSSF Group.
Regulations 1999. NB. There audits will be undertaken for
are 14 questions listed in the a sample of all teams utilising
audit template that are a standard audit template via
assessed for compliance. an internet-based audit
platform. Results are collated
and discussed at Health,
Safety, Security and Fire
Group (HSSF GROUP) with
a report to be submitted to
the appropriate committee.
Responsible: Undertaken by
members of the Health and
Safety Team as directed by
the Head of Health, Safety
and Security.
10 References
 Health & Safety at Work Act 1974

 Management of Health and Safety at Work Regulations 1999 (MHSWR)
 Managing for Health and Safety HSG65
 HSE website: Consulting employees whose first language is not English (hse.gov.uk,
accessed 1st June 2022)
 HSE website: Young people at work (hse.gov.uk, accessed 1st June 2022)
 HSE website: Diversity in the workplace - New to the job (hse.gov.uk, accessed 1st June
2022)

11 Document control (external)
To be recorded on the policy register by Policy Coordinator
Date of approval 02 April 2024

Next review date 02 April 2027
This document replaces HS-0001-017-v1
This document was EFM DMT
approved by
This document was 12 March 2024
approved
This document was ratified Health, Safety, Security and Fire Group
by
This document was ratified 02 April 2024
An equality analysis was 12 January 2024
completed on this policy on
Document type Public
FOI Clause (Private n/a

documents only)
Change Record

Version Date Amendment details Status
1 03 April 2023 New document Withdrawn
1 26 April 2023 Minor formatting changes due to Withdrawn

accessibility reviewed on risk assessment.
No change to content
1 05 June Document control updated to show full Withdrawn
2023 approval information. No change to
content.
2 02 Apr 2024 Full review and clarified wording. Approved
Added additional guidance into section 5.0:
• Added section 5.3
Added additional Appendix 2

Appendix 1 – Risk Assessment Form
An MS Word Version of this risk assessment form is available on the T-Drive located here (copy file path and paste into file explorer pathway):
T:\Intranet Published Documents\Working here\Health and Safety\Health and safety toolkit\Risk Assessments
Risk Assessment
Location:
Document Reference No.:
Date of Risk Assessment:
Work Area:
Task Being Assessed:
Review Date:
Key: L = Likelihood S= Severity R = Rating

Risk Rating: L x S = R
Residual Risk
Rating with
Existing risk
Who might additional
Item What is the assessment Additional control measures to be
be harmed Existing risk control measures control
No. hazard? rating applied
and how? measures
applied
L S R L S R

Residual Risk
Rating with
Existing risk
Who might additional
Item What is the assessment Additional control measures to be
be harmed Existing risk control measures control
No. hazard? rating applied
and how? measures
applied
L S R L S R
Name of Assessor:
Signature of Assessor:
Name of Manager:
Signature of Manager:
A more accessible version of the risk assessment is available upon request.

Risk Matrix R (Risk) = L (Likelihood) x S (Severity)
Severity
1 2 3 4 5
Insignificant Minor Moderate Major Catastrophic
5 Almost Certain 5 10 15 20 25
Likelihood
4 Likely 4 8 12 16 20
3 Possible 3 6 9 12 15
2 Unlikely 2 4 6 8 10
1 Rare 1 2 3 4 5
Severity Descriptor Examples:

1 Insignificant 2 Minor 3 Moderate 4 Major 5 Catastrophic
• Minimal Injury • Minor injury or illness, • Moderate injury • Major injury leading to • Incident leading to
requiring no/minimal requiring minor requiring professional long-term death
intervention or intervention intervention incapacity/disability • Multiple permanent
treatment • Requiring time off work • Requiring time off work • Requiring time off work injuries or irreversible
• No time off work for <3 days for 4-14 days for >14 days health effects
• Increase in length of • Increase in length of • Increase in length of • An event which
hospital stay by 1-3 hospital stay by 4-15 hospital stay by > 15 impacts on a large
days days days number of patients
• RIDDOR/agency • Mismanagement of
reportable incident patient care with long-
• An event which term effects
impacts on a small
number of patients

Outstanding Action Log
Recommended Actions Priority Target Responsible Person / Actions Taken and Date
Rating Date Department Comments Completed

Appendix 2 – Further Information on the 5 Steps to Risk Assessment
1. Identify the hazards:

• Accurately identify the potential hazards in your workplace.
• Walk around your workplace and think about the potential hazards.
• What is it about the activities, processes or substances used that could injure your
employees or harm their health?
• There are some hazards with a recognised risk of harm, for example working at
height, working with chemicals, machinery, and asbestos.
• Some tips for identifying hazards are:
• Check manufacturers’ instructions or data sheets.
• Accident and ill-health records.
• Non-routine operations are particularly hazardous (e.g. maintenance, cleaning
operations or changes in work).
• Think about long-term hazards to health (e.g. high levels of noise or exposure to
harmful substances).
2. Assess:
• Think about who might be harmed and how?
i. Trust staff, staff from other organisations, contractors, visitors, students,
patients, members of the public etc. Be specific for each identified hazard.
• Shared workplace?
i. Consider how your work affects others and how their work affects you and
your workers.
ii. Communication between parties is key.
• Involve staff in the risk assessment process.
• Some workers will require specific control measures, e.g. new and young workers,
new and expectant mothers/people, people with disabilities, temporary workers,
contractors, homeworkers and lone workers.
3. Evaluate the risks:

• For each hazard identify how likely it will be for harm to occur.
• You must understand the risks and how to manage them appropriately.
• You need to do everything ‘reasonably practicable’ to protect people from harm. This
means balancing the level of risk against the measures needed to control them.
• The greater the hazard the more robust and reliable the measures to control the risk
of an injury occurring will need to be.
• Risk mitigation MUST employ the hierarchy of control, and this should be at the
forefront when thinking about control measures.
• You must check that any control measures that you put into place do not create other
hazards.

4. Record:
• Record your significant findings.
• Any record produced should be simple and focussed on controls.
• A risk assessment must be ‘suitable and sufficient’ i.e. it should show that:
i. A proper check was made.
ii. You have identified who might be affected.
iii. You dealt with all the obvious significant hazards, taking into account the
number of people who could be involved.
iv. The precautions are reasonable, and the remaining risk is low.
v. You involved your employees or their representatives in the process.
5. Review:
• Review what you are doing on an ongoing basis:
i. Have there been any significant changes?
1. Legislative changes, guidance, task/activity, equipment/processes,
people.
ii. Are there improvements you still need to make?
1. Control measures are not working effectively (i.e. you observe workers
are not following the risk assessment control measures).
iii. Have your workers spotted a problem?
iv. Have you learnt anything from accidents or near misses?

Appendix 3 – Risk Assessment Top Tips
1. Ensure that at least two, preferably three, people who understand the task are involved in
the creation and reviewing of risk assessments.
2. Involve those who carry out the task / use equipment in the writing and review of risk
assessments.
3. Make sure those completing risk assessments are competent. This can be defined as those
with the necessary Knowledge, Ability, Training, and Experience (KATE) to identify hazards
and implement sensible, proportionate solutions.
4. Within the risk assessment, ensure that you consider how a person can be injured and the
resulting injury (i.e., punch to head resulting in head injury, etc.).
5. Reference applicable guidance, both from the HSE, trade associations and relevant TEWV
Policies and Procedures.
6. Look to cross reference to other risk assessments that are in place to prevent duplication.
7. Avoid generic, ambiguous terms such as ‘heavy and PPE’. Instead use more precise weight
measurements, for example ‘<25kg’, and be explicit with the PPE to be worn and the
standard of the PPE item. Be specific with statements for example ‘a person will/must/shall
use hearing protection’, etc.
8. Make sure you communicate the findings of risk assessments to staff and obtain
documented evidence that this has been seen.
9. Ensure that risk assessments are reviewed regularly.
10. Have an index in place which lists all assessments, and the dates reviews are required, to
provide a quick reference guide.

Appendix 4 – Is Your Risk Assessment Suitable and Sufficient? Checklist
Is my risk assessment approach suitable and sufficient?
If you can answer ‘yes’ to all the questions, then your approach is likely to be considered a suitable
and sufficient risk assessment.
Question Yes No
Have you completed all 5 steps of the risk assessment process?
Does it identify the significant risks?
Are the details proportionate to the risk?
Have you considered and documented all those who might be affected by the
activities?
Have you considered and documented how all those affected could be harmed
and how?
The precautions / mitigations / control measures are reasonable?
The remaining/residual risk is low?
Have all relevant parties been involved in the risk assessment process?
Have the risk assessments been communicated to all staff?
Are the risk assessments available to all staff?
Has evidence been retained of all communication?
Have you got a register in place documenting all of your risk assessments?
Have reviews of the risk assessments been logged / evidenced?
It is importance that you document what you have done in regard to following the risk assessment
process.
Documenting the process, you have followed provides an audit trail to help you demonstrate to
relevant parties that what you have done represents a suitable and sufficient risk assessment.

Appendix 5 - Equality Analysis Screening Form
Please note: The Equality Analysis Policy and Equality Analysis Guidance can be found on the policy pages of the intranet
Section 1 Scope
Name of service Health & Safety, EFM
area/directorate/department
Title Risk Assessment Procedure
Type Procedure
Geographical area covered Trust wide

Aims and objectives The objectives of this procedure are to:
• Comply at all times with the Health and Safety at Work etc. Act 1974 etc., the
Management of Health and Safety at Work Regulations 1999 and all other relevant
statutory provisions;
• Manage health and safety effectively to improve the quality of patient care,
visitors and working conditions of staff and others.
Start date of Equality Analysis Screening 01 December 2023
End date of Equality Analysis Screening 12 January 2024
Section 2 Impacts
Who does the Policy, Service, Function, All staff, patients, contractors and visitors and the general community.
Strategy, Code of practice, Guidance, Project
or Business plan benefit?
Will the Policy, Service, Function, Strategy, • Race (including Gypsy and Traveller) NO
Code of practice, Guidance, Project or
• Disability (includes physical, learning, mental health, sensory and medical
disabilities) NO
Business plan impact negatively on any of the • Sex (Men, women and gender neutral etc.) NO
protected characteristic groups?
• Gender reassignment (Transgender and gender identity) NO
• Sexual Orientation (Lesbian, Gay, Bisexual, Heterosexual, Pansexual and
Asexual etc.) NO
• Age (includes, young people, older people – people of all ages) NO
• Religion or Belief (includes faith groups, atheism and philosophical beliefs)
NO
• Pregnancy and Maternity (includes pregnancy, women who are breastfeeding
and women on maternity leave) NO
• Marriage and Civil Partnership (includes opposite and same sex couples who
are married or civil partners) NO
• Armed Forces (includes serving armed forces personnel, reservists, veterans and
their families NO
Describe any negative impacts There will be times when health and safety has to take priority and this may have an
impact on a person’s protected characteristics. TEWV would however always try
and mitigate as much as possible any negative impact whilst ensuring health and
safety legislation is followed.
Describe any positive impacts Procedure is in place to reduce risk to all staff, patients, visitors, contractors etc.
The risk assessment process considers peoples protected characteristics.
Section 3 Research and involvement

What sources of information have you Health & Safety at Work Act 1974
considered? (e.g. legislation, codes of Management of Health and Safety at Work Regulations 1999 (MHSWR)
practice, best practice, nice guidelines,
CQC reports or feedback etc.)

Have you engaged or consulted with service Yes
users, carers, staff and other stakeholders
including people from the protected groups?
If you answered Yes above, describe the Programme of visits and audits have been undertaken where concerns have been
engagement and involvement that has taken discussed and documented. These have been considered while reviewing the
place procedure.
If you answered No above, describe future
plans that you may have to engage and
involve people from different groups
Section 4 Training needs

As part of this equality analysis have any No
training needs/service needs been identified?
Describe any training needs for Trust staff N/A

Describe any training needs for patients N/A
Describe any training needs for contractors or N/A
other outside agencies
Check the information you have provided and ensure additional evidence can be provided if asked

Appendix 6 – Approval checklist
Yes / No /
Title of document being reviewed: Not Comments
applicable
1. Title
Is the title clear and unambiguous? Yes
Is it clear whether the document is a guideline,

Yes
policy, protocol or standard?
2. Rationale
Are reasons for development of the document

Yes
stated?
3. Development Process
Are people involved in the development

Yes
identified?
Has relevant expertise has been sought/used? Yes
Is there evidence of consultation with

Yes
stakeholders and users?
Have any related documents or documents

that are impacted by this change been Yes
identified and updated?
4. Content
Is the objective of the document clear? Yes
Is the target population clear and

Yes
unambiguous?
Are the intended outcomes described? Yes
Are the statements clear and unambiguous? Yes

5. Evidence Base
Is the type of evidence to support the

Yes
document identified explicitly?
Are key references cited? Yes
Are supporting documents referenced? Yes
6. Training
Have training needs been considered? Yes
Are training needs included in the document? Yes
7. Implementation and monitoring
Does the document identify how it will be

Yes
implemented and monitored?

Yes / No /
Title of document being reviewed: Not Comments
applicable
8. Equality analysis
Has an equality analysis been completed for

Yes
the document?
Have Equality and Diversity reviewed and
Yes 12 January 2024
approved the equality analysis?
9. Approval
Does the document identify which

Yes
committee/group will approve it?
10. Publication
Has the policy been reviewed for harm? Yes
Does the document identify whether it is

Yes Public .
private or public?
If private, does the document identify which
clause of the Freedom of Information Act 2000 Yes
applies?


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Public - To be published on the Trust external website

Risk Assessment (H&S) Procedure

Ref: HS-0001-017-v2 Page 1 of 26 Ratified date: 02 April 2024

Ref: HS-0001-017-v2 Page 2 of 26 Ratified date: 02 April 2024

3 Who this procedure applies to

This procedure also refers to:

 Organisational Risk Management Policy

Ref: HS-0001-017-v2 Page 3 of 26 Ratified date: 02 April 2024

Managers need to:

• Identify the risks the team are exposed to.

Ref: HS-0001-017-v2 Page 4 of 26 Ratified date: 02 April 2024

• “Identify your risk profile:

The Plan, Do, Check, Act cycle - Reference HSG65

Ref: HS-0001-017-v2 Page 5 of 26 Ratified date: 02 April 2024

Effective risk assessment is based on a series of steps:

Further information on the 5 steps to risk assessment can be found in Appendix 2.

Top tips on risk assessment can be found in Appendix 3.

5.3 Reviewing Control Measures and Risk Assessments

You should also review them if:

Planned reviews can also be undertaken.

Ref: HS-0001-017-v2 Page 6 of 26 Ratified date: 02 April 2024

5.5 Suitable and Sufficient

Ref: HS-0001-017-v2 Page 7 of 26 Ratified date: 02 April 2024

Effective health and safety is the robust management of risk.

Least PPE / RPE

The hierarchy of control uses a systematic approach:

5.7 Risk Matrix

6 Health, Safety and Security Team

Ref: HS-0001-017-v2 Page 8 of 26 Ratified date: 02 April 2024

Risk • The likelihood that a person may be harmed or

Risk Reduction • The process by which the risk is managed to reduce

Risk Assessment • Is a systematic evaluation of a work task or facility to

Risk Management • Is the process of deciding what to do when the risks

Control Measures • Mitigations in place to reduce risk.

8 How this procedure will be implemented

• This procedure will be published on the Trust’s intranet.

Staff/Professional Type of Training Duration Frequency of Training

All staff Risk Assessment 1 hour 2 yearly

Supervisors and Risk Assessment 1 day 2 yearly

Ref: HS-0001-017-v2 Page 10 of 26 Ratified date: 02 April 2024

Number Auditable Standard/Key Frequency/Method/Person Where results and any

 Health & Safety at Work Act 1974

Ref: HS-0001-017-v2 Page 11 of 26 Ratified date: 02 April 2024

Date of approval 02 April 2024

FOI Clause (Private n/a

Ref: HS-0001-017-v2 Page 12 of 26 Ratified date: 02 April 2024

1 26 April 2023 Minor formatting changes due to Withdrawn

Ref: HS-0001-017-v2 Page 13 of 26 Ratified date: 02 April 2024

Key: L = Likelihood S= Severity R = Rating

Ref: HS-0001-017-v2 Page 14 of 26 Ratified date: 02 April 2024

Ref: HS-0001-017-v2 Page 15 of 26 Ratified date: 02 April 2024

Severity Descriptor Examples:

Ref: HS-0001-017-v2 Page 16 of 26 Ratified date: 02 April 2024

Ref: HS-0001-017-v2 Page 17 of 26 Ratified date: 02 April 2024

1. Identify the hazards:

3. Evaluate the risks:

Ref: HS-0001-017-v2 Page 18 of 26 Ratified date: 02 April 2024

Ref: HS-0001-017-v2 Page 19 of 26 Ratified date: 02 April 2024

9. Ensure that risk assessments are reviewed regularly.