Health and Safety

Preliminary Checklist for Pregnant Lab Worker

Dublin City University Health & Safety Office
Preliminary Checklist for Pregnant Lab Worker

NAME:   DATE:
PHONE NUMBER:   DOB:
JOB TITLE:   LOCATION:
NAME AND ADDRESS OF YOUR FAMILY DOCTOR:    
HAVE YOU BEEN CERTIFIED PREGNANT: YES NO
WHAT IS YOUR DUE DATE:
HAVE YOU NOTIFIED YOUR SUPERVISOR/MANAGER YES NO
SUPERVISOR/MANAGER NAME:
SUPERVISOR/MANAGER CONTACT PHONE NUMBER

DO YOU WISH THE H&S OFFICE TO CONTACT YOU REGARDING SPECIFIC SAFETY ISSUES IN PREGNANCY? 

 YES NO

PRELIMARY JOB ASSESSMENT

Does your Job involve?

Exposure to excessive noise? YES NO
Exposure to Biological or Chemical Agents? YES NO
Vibration or Shocks? YES NO
Manual Handling? YES NO
Cold Environment? YES NO
Hot Environment? YES NO
Ionising Radiation? YES NO
Non-Ionising Radiation? YES NO
Night Work? YES NO

THE WORKING ENVIRONMENT - GENERAL

Do you work alone? YES NO
Have you completed Lone Worker Training? YES NO
Do you have means of communicating in an emergency? YES NO
Are you aware of first aid arrangements? YES NO
Are you required to undertake dual tasks at one time? YES NO
Do you work within pressurised enclosures? YES NO
Are you required to wear/provided with any personal protective equipment (PPE) YES NO
If YES list PPE provided:  

Is your working environment:

Very hot YES NO
Very cold YES NO
Very Humid YES NO
Poorly Lit YES NO
Very Dusty YES NO
Very Windy YES NO
Odorous YES NO

THE WORKING ENVIRONMENT - MANUAL HANDLING

Do you routinely lift items weighing more than 10kg? YES NO
Have you undergone manual handling training? YES NO
Does your work involve periods in excess of 1 hour at a time sitting or standing? YES NO
Are you required to access ladders/platforms at height? YES NO

THE WORKING ENVIRONMENT - BIOLOGICAL AGENTS

Does your job involve likely exposure to Biological Agents? YES NO
IF 'NO' PROCEED TO SECTION ON CHEMICALS
Is this exposure in the form of;
Bacteria? YES NO
Virus? YES NO
Is Personal Protective Equipment Provided if required? YES NO
Is there possible exposure to
Toxoplasmosis? YES NO
Rubella? YES NO

THE WORKING ENVIRONMENT - CHEMICAL AGENTS

Does your job involve likely exposure to any of the following chemicals?
Lead or lead derivaties? YES NO
Carinogens? (R45) YES NO
Mercury or mercury derivaties? YES NO
Cytotoxic drugs? YES NO
Carbon monoxide? YES NO
Are any the following risk phases identified on the MSDS for each chemical to which you are exposed?
R40 - possible risk of irreversible effect YES NO
R45 - may cause cancer YES NO
R46 - may cause heritable genetic damage YES NO
R49 - may cause cancer by inhalation YES NO
R61 - may cause harm to the unborn child YES NO
R63 - possible risk of harm to the unborn child YES NO
R64 - may cause harm to breastfed babies YES NO
R69 - possible risk of irreversible effects YES NO

If YES please list each chemical in use and its specified risk phase.

Chemical Name Risk Phases (e.g. R61, R64)

THE WORKING ENVIRONMENT - VISUAL DISPLAY UNITS

Does the task involve using a VDU? YES NO
Have you completed the web based VDU Risk Assessment on your workstation? YES NO
Have you attended the office ergonomic training programme? YES NO
Have you been provided with information on the safe use of VDUs? YES NO

THE WORKING ENVIRONMENT - SHOCKS, VIBRATION

Does the task involve regular exposure to shocks / vibrations? YES NO
How frequent do the shocks / vibrations occur?  

Please note any concerns relating to pregnancy and work?

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