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Smokers risk assessment form v 1.0.docx.docx
This document is a smoker's risk assessment form for residents at a care centre. It collects information about the resident's mobility, impairments, and ability to respond in an emergency. It also assesses smoking areas at the facility, including internal rooms, external areas, safety features, and evacuation procedures. The form is used to evaluate risks of smoking and identify control measures to manage safety. It must be updated every 3 months or if a new risk is found.
Smokers risk assessment form v 1.0.docx.docx
- 1. Smokers Risk AssessmentForm Name of Care Centre This Smokers Risk Assessment Form Was Prepared For Name of Resident The 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. Smokers Risk AssessmentForm While smoking is no longer permitted in enclosed buildings, there may be some areas where it is permitted (for example long-stay nursing homes and mental health facilities). In these circumstances, due regard should be taken of the fire risk this poses. Smoking safety must be listed in the Care Centres Fire Safety Policy. This Smokers Risk Assessmenthas been prepared by PHOENIX SAFETY TRAINING SERVICES; its purpose is to identify the individual risks to a resident with regard to their safe when smoking. The Smokers Risk Assessment should be completed ONLY by a COMPETENT PERSON as defined in the Safety Health and Welfare at Work Act 2005. The Smokers Risk Assessmentis not exhaustive and where additional requirements are identified they should be entered in under “Other Information” showing any remedial actions deemed necessary. Each resident who is a smoker should have a Smokers Risk Assessment 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 be used inside or outside of normal working hours. It is likely that certain areas of the Care Centre will be inaccessible outside of normal working hours e.g. to assure security. The Smokers Risk Assessment needs to demonstrate that this has been adequately considered. If the Smokers Risk Assessment deems that a particular area does not meet the general access requirements for the resident being assessed then alternative management arrangements will need to be identified. Once these arrangements have been identified then a new Smokers Risk Assessment will need to be undertaken. The Assessor should complete new Smokers Risk Assessment and send it to the Person in Charge of the Care Centre. The Smokers Risk Assessment should be updated at least every 3 months or on finding of a risk assessment that’s show the previous Smokers Risk Assessmentis out of date. Phoenix Safety Training Services does NOT accept any responsibility for the misinterpretation or assessments carried out by any individual completing the Smokers Risk Assessment. The content of the Smokers Risk Assessmentis subject to COPYRIGHT and cannot be transcribed. If you require any additional information on the interpretation or use of the Smokers Risk Assessmentplease contact 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. Smokers Risk AssessmentForm Assessor Name of Assessor;Name Assessor Position; Choose Position Other; If Other Date of Assessment; Date Time of Assessment;Hour:Mins What times or daysare covered by this assessment?Assessment Time/Day Section 1 – Residents Information Age;Age D.O.B; Date Nature ofImpairment(s); Nature ofImpairment(s) Is the resident a wheelchair user? Yes/No Type; TypeSize;Sizemm If YES Enter Details Does the resident use other types of mobility aids? Yes/No Type; Type of Mobility Aid If YES Enter Details Has the resident a visual impairment? Yes/No If YES Enter Details Has the resident a hearing impairment? Yes/No If YES Enter Details Can the resident raise the alarm if they discover a fire (operate the manual call point)? Yes/No If NO Enter Details In an emergency can the resident contact staff in the area in which the resident is located? Yes/No If NO Enter Details Does the resident required assistance to get in/out of the smoking room/area? Yes/No If YES EnterDetails Can the resident move quickly in the event of an emergency? Yes/No If 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. Smokers Risk AssessmentForm Is the resident on oxygen therapy? Yes/No If YES Enter Details Section2– Only forInternal Smoking Room Is there an internal smoking room?Yes/No Floor; Floor Room No.Room No. Is the fire door fitted with fire rated glazing? Yes/No If No Enter Details Is smoking room fitted with closed-circuit television (CCTV) (not to record monitor only)?Yes/No If No Enter Details If CCTV is in use approximate distance in meters from monitoring station from internal smoking room Metersm How long would you estimate that it would take to reach the resident from the monitoring station in the event of an emergency? Time Minute(s) Approximate distance in meters from closest Fire Point to internal smoking room Metersm Is smoking room fitted with fire detection?Yes/No If yes; Type of detection; Type of Detection If No Enter Details Is smoking room fitted with emergency lighting?Yes/No If No Enter Details Are all Textiles and Furnishings compliant with current Sanders stands?Yes/No If No Enter Details Maximum number of resident that could be in the smoking room/area at any time; Number of Resident Section3– External Smoking Area Is there an external smoking area?Yes/No Is 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. Smokers Risk AssessmentForm If CCTV is in use approximate distance in meters from monitoring station from external smoking area Metersm How long would you estimate that it would take to reach the resident from the monitoring station in the event of an emergency? Time Minute(s) Approximate distance in meters from closest Fire Point to external smoking area Metersm Is smoking area fitted with fire detection?Yes/No If yes; Type of detection; Type of Detection If No Enter Details Is smoking area fitted with emergency lighting?Yes/No If No Enter Details Are all Textiles and Furnishings compliant with current Sanders stands?Yes/No If No Enter Details Maximum number of resident that could be in the smoking room/area at any time; Number of Resident Section4 – Staff Has staff practiced appropriate evacuation drill to meet the resident’s needs if in the smoking room/area? Yes/No If NO Enter Details Is there an up-to-date record of staff receiving training in the use of Fire Extinguishers? Yes/No If NO Enter Details Section 5 – Control Measures Risk Assessment Risk Likelihood Severity Overall Risk Physical Injury for Smoking Choose Choose Choose Key Risks Location 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. Smokers Risk AssessmentForm Risk 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 Health ResidentComprehension; Resident Comprehension Control Measures Active 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 Choose Other Information; Other Information As the Assessor do you denote that the Care Centre can manage the safety of the resident when smoking? Yes/No Signed (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. Smokers Risk AssessmentForm Annex 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. Smokers Risk AssessmentForm Annex 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 9 Likelihood 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