Smokers risk assessment form v 1.0.docx.docx

4,417 views
4,064 views

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
4,417
On SlideShare
0
From Embeds
0
Number of Embeds
76
Actions
Shares
0
Downloads
53
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Smokers risk assessment form v 1.0.docx.docx

  1. 1. Smokers Risk Assessment FormName of Care CentreThis Smokers Risk Assessment Form Was Prepared ForName of ResidentThe content of this document is confidential © Phoenix Safety Training Services – Unit 21, Redleaf House, Townspark, Longford. Tel/Fax: +353 (0) 43 3349611 Email:info@phoenixsts.ieWeb:www.phoenixsts.ie V1.0 – Page 1 of 8
  2. 2. Smokers Risk Assessment FormWhile smoking is no longer permitted in enclosed buildings, there may be some areas where it ispermitted (for example long-stay nursing homes and mental health facilities). In these circumstances, dueregard should be taken of the fire risk this poses. Smoking safety must be listed in the Care Centres FireSafety Policy.This Smokers Risk Assessmenthas been prepared by PHOENIX SAFETY TRAINING SERVICES; itspurpose is to identify the individual risks to a resident with regard to their safe when smoking. TheSmokers Risk Assessment should be completed ONLY by a COMPETENT PERSON as defined in theSafety Health and Welfare at Work Act 2005. The Smokers Risk Assessmentis not exhaustive and whereadditional requirements are identified they should be entered in under “Other Information” showing anyremedial actions deemed necessary. Each resident who is a smoker should have a Smokers RiskAssessment prepared prior to their arrival or if already a resident within the Care Centre.It is important to distinguish in the Smokers Risk Assessment whether the area to be accessed will beused inside or outside of normal working hours. It is likely that certain areas of the Care Centre will beinaccessible outside of normal working hours e.g. to assure security. The Smokers Risk Assessment needsto demonstrate that this has been adequately considered.If the Smokers Risk Assessment deems that a particular area does not meet the general accessrequirements for the resident being assessed then alternative management arrangements will need to beidentified. Once these arrangements have been identified then a new Smokers Risk Assessment will needto be undertaken. The Assessor should complete new Smokers Risk Assessment and send it to the Personin Charge of the Care Centre.The Smokers Risk Assessment should be updated at least every 3 months or on finding of a riskassessment that’s show the previous Smokers Risk Assessmentis out of date.Phoenix Safety Training Services does NOT accept any responsibility for the misinterpretation orassessments carried out by any individual completing the Smokers Risk Assessment.The content of the Smokers Risk Assessmentis subject to COPYRIGHT and cannot be transcribed. Ifyou require any additional information on the interpretation or use of the Smokers Risk Assessmentpleasecontact Phoenix Safety Training Services at info@phoenixsts.ie or on 043 3349611.For more information on smokers safety in Care Centres visit; http://www.phoenixsts.ie/shop/For more information on fire safety training in Nursing Home/Care Centres visit;http://www.phoenixsts.ie/nursing-home-safety/ © Phoenix Safety Training Services – Unit 21, Redleaf House, Townspark, Longford. Tel/Fax: +353 (0) 43 3349611 Email:info@phoenixsts.ieWeb:www.phoenixsts.ie V1.0 – Page 2 of 8
  3. 3. Smokers Risk Assessment Form AssessorName of Assessor;NameAssessor Position; Choose Position Other; If OtherDate of Assessment; Date Time of Assessment;Hour:MinsWhat times or daysare covered by this assessment?Assessment Time/Day Section 1 – Residents InformationAge;Age D.O.B; DateNature ofImpairment(s);Nature ofImpairment(s)Is the resident a wheelchair user? Yes/No Type; TypeSize;SizemmIf YES Enter DetailsDoes the resident use other types of mobility aids? Yes/No Type; Type of Mobility AidIf YES Enter DetailsHas the resident a visual impairment? Yes/NoIf YES Enter DetailsHas the resident a hearing impairment? Yes/NoIf YES Enter DetailsCan the resident raise the alarm if they discover a fire (operate the manual call point)? Yes/NoIf NO Enter DetailsIn an emergency can the resident contact staff in the area in which the resident is located? Yes/NoIf NO Enter DetailsDoes the resident required assistance to get in/out of the smoking room/area? Yes/NoIf YES EnterDetailsCan the resident move quickly in the event of an emergency? Yes/NoIf NO Enter Details © Phoenix Safety Training Services – Unit 21, Redleaf House, Townspark, Longford. Tel/Fax: +353 (0) 43 3349611 Email:info@phoenixsts.ieWeb:www.phoenixsts.ie V1.0 – Page 3 of 8
  4. 4. Smokers Risk Assessment FormIs the resident on oxygen therapy? Yes/NoIf YES Enter Details Section2– Only forInternal Smoking RoomIs there an internal smoking room?Yes/NoFloor; Floor Room No.Room No.Is the fire door fitted with fire rated glazing? Yes/NoIf No Enter DetailsIs smoking room fitted with closed-circuit television (CCTV) (not to record monitor only)?Yes/NoIf No Enter DetailsIf CCTV is in use approximate distance in meters from monitoring station from internal smoking roomMetersmHow long would you estimate that it would take to reach the resident from the monitoring station in theevent of an emergency? Time Minute(s)Approximate distance in meters from closest Fire Point to internal smoking room MetersmIs smoking room fitted with fire detection?Yes/No If yes; Type of detection; Type of DetectionIf No Enter DetailsIs smoking room fitted with emergency lighting?Yes/NoIf No Enter DetailsAre all Textiles and Furnishings compliant with current Sanders stands?Yes/NoIf No Enter DetailsMaximum number of resident that could be in the smoking room/area at any time; Number of Resident Section3– External Smoking AreaIs there an external smoking area?Yes/NoIs smoking area fitted with CCTV (not to record monitor only)?Yes/No © Phoenix Safety Training Services – Unit 21, Redleaf House, Townspark, Longford. Tel/Fax: +353 (0) 43 3349611 Email:info@phoenixsts.ieWeb:www.phoenixsts.ie V1.0 – Page 4 of 8
  5. 5. Smokers Risk Assessment FormIf CCTV is in use approximate distance in meters from monitoring station from external smoking areaMetersmHow long would you estimate that it would take to reach the resident from the monitoring station in theevent of an emergency? Time Minute(s)Approximate distance in meters from closest Fire Point to external smoking area MetersmIs smoking area fitted with fire detection?Yes/No If yes; Type of detection; Type of DetectionIf No Enter DetailsIs smoking area fitted with emergency lighting?Yes/NoIf No Enter DetailsAre all Textiles and Furnishings compliant with current Sanders stands?Yes/NoIf No Enter DetailsMaximum number of resident that could be in the smoking room/area at any time; Number of Resident Section4 – StaffHas staff practiced appropriate evacuation drill to meet the resident’s needs if in the smoking room/area?Yes/NoIf NO Enter DetailsIs there an up-to-date record of staff receiving training in the use of Fire Extinguishers? Yes/NoIf NO Enter Details Section 5 – Control Measures Risk Assessment Risk Likelihood Severity Overall Risk Physical Injury for Smoking Choose Choose Choose Key RisksLocation of Smoking;Location of Smoking © Phoenix Safety Training Services – Unit 21, Redleaf House, Townspark, Longford. Tel/Fax: +353 (0) 43 3349611 Email:info@phoenixsts.ieWeb:www.phoenixsts.ie V1.0 – Page 5 of 8
  6. 6. Smokers Risk Assessment FormRisk Indicators;Burns to furnishings in smoking room/area;☐ Burns to bedding in resident room; ☐Burns to upholstered furniture in resident room; ☐ Burns to residents clothing;☐Burns to furnishingsin resident room; ☐ Burns to floor in residentsroom; ☐Nature ofResidentImpairment(s);Resident Health;Resident HealthResidentComprehension;Resident Comprehension Control MeasuresActive Monitoring of Resident when Smoking;☐ Smokers Protective Apron for Resident;☐Every half-hourInspection of Smoking Room/Area ☐ CiglowFlameless Lighter; ☐Other Control Measures;Other Control Measures Residual Risk Assessment Risk Likelihood Severity Overall Risk Physical Injury for Smoking Choose Choose ChooseOther Information;Other InformationAs the Assessor do you denote that the Care Centre can manage the safety of the resident when smoking?Yes/NoSigned (Assessor) _________________________________ © Phoenix Safety Training Services – Unit 21, Redleaf House, Townspark, Longford. Tel/Fax: +353 (0) 43 3349611 Email:info@phoenixsts.ieWeb:www.phoenixsts.ie V1.0 – Page 6 of 8
  7. 7. Smokers Risk Assessment FormAnnex 1 Section 5 – Control Measures Initial Risk Assessment (Risk = Likelihood + Severity) Severity Insignificant = 1 Minor = 2 Moderate = 3 Major = 4 Catastrophic = 5 Likelihood Almost Certain = 5 6 7 8 9 10 Likely = 4 5 6 7 8 9 Possible = 3 4 5 6 7 8 Unlikely = 2 3 4 5 6 7 Rare =1 2 3 4 5 6 Hazard Rating Number Interpretation 1 – 4 = Low Risk No action required – Manage by routine procedures. Will not be accepted, additional control measures must be considered and the risks reduced 5= Medium Risk to Low, inform the Person in Charge. Will not be accepted, smoking will stop additional control measures must be considered 6 – 10 = High Risk and the risks reduced to Low, inform the Person in Charge. MediumandHighandrisks must be reported to Person in Charge and reduce the risk to Low © Phoenix Safety Training Services – Unit 21, Redleaf House, Townspark, Longford. Tel/Fax: +353 (0) 43 3349611 Email:info@phoenixsts.ieWeb:www.phoenixsts.ie V1.0 – Page 7 of 8
  8. 8. Smokers Risk Assessment FormAnnex 2 Risk Assessment Matrix Consequence Injuries or ailments not Serious injury causing Life threatening injury or People/ requiring medical Minor injury or First Aid hospitalisation or multiple multiple serious injuries Death or multiple life Resident Treatment Case. threatening injuries. treatment. medical treatment cases. causing hospitalisation. Examination required by Intense public, political Examination required by Assembly inquiry or internal committees or and media scrutiny. eg: Reputation Internal Review internal audit to prevent external committees or front page headlines, TV, Commission of inquiry or inquest, etc. adverse national media. escalation. etc. Critical system failure, Policy procedural rule Strategies not consistent Business Process & Minor errors in systems One or more key bad policy advice or on- occasionally not met or with Government’s or processes requiring accountability going non-compliance. Systems services do not fully meet agenda. Trends show corrective action. requirements not met. Business severely needs. service is degraded. affected. 1% of Budget 2.5% of Budget > 5% of Budget > 10% of Budget >25% of Budget Financial or <€5K or <€50K or <€500K or <€5M or >€5M Insignificant Minor Moderate Major Catastrophic Numerical: Historical: 1 2 3 4 5 Is expected to occur in most circumstances >1 in 10 Almost Certain 5 6 7 8 9 10 Will probably occur 1 in 10 - 100 Likely 4 5 6 7 8 9Likelihood Might occur at some 1 in 100 – 1,000 time in the future Possible 3 4 5 6 7 8 Could occur but 1 in 1,000 – 10,000 doubtful Unlikely 2 3 4 5 6 7 May occur but only in 1 in 10,000 – 100,000 exceptional circumstances Rare 1 2 3 4 5 6 © Phoenix Safety Training Services – Unit 21, Redleaf House, Townspark, Longford. Tel/Fax: +353 (0) 43 3349611 Email:info@phoenixsts.ieWeb:www.phoenixsts.ie V1.0 – Page 8 of 8

×