Direct Slips, Trips and Falls Policy
Direct Slips, Trips and Falls Policy Version: 2.0 Ratified by: Date ratified: Name and Title of originator/author(s): Steve Duncan Estates & Facilities Manager Name of responsible Director: Lee Whitehead - Director of People and Communications Date issued: 18.07.2013 Review date: 18.07.2014 Target audience: Members of staff employed by Health Education England. Anyone for whom HEE has a legal responsibility. Staff covered by a letter of authority/honorary contract or work experience. Third parties and other authorised to undertake work on behalf of HEE. Document History: Date: 15.07.2013 Date: 22.07.2013 Date: 15.11.2013 Date: 15.11.2013 Version 1.0: Issued for consideration by Corporate Secretary. Version 1.0: Approved by OMEC Version 1.0: Reviewed prior to issue Version 2.0: Issued Developing people for health and healthcare Page 1 www.hee.nhs.uk hee.enquiries@nhs.net @NHS_HealthEdEng
Executive Summary Slips and trips are the most common cause of injury at work. On average, they cause 40 per cent of all reported major injuries and can also lead to other types of serious accidents, for example falls from height. Slips and trips are also the most reported injury to members of the public. The Health and Safety at Work Act 1974 (HSW Act) requires employers to ensure the health and safety of all employees and anyone who may be affected by their work, so far as is reasonably practicable. This includes taking steps to control slip and trip risks. Employees have a duty not to put themselves or others in danger, and must use any safety equipment provided. The Management of Health and Safety at Work Regulations 1999 require employers to assess risks (including slip and trip risks) and, where necessary, take action to address them. The Workplace (Health, Safety and Welfare) Regulations 1992 require floors to be suitable, in good condition and free from obstructions. People should be able to move around safely. We must manage the health and safety risks in our workplace. To do this we need to decide whether we are doing enough to prevent harm. This process is known as a risk assessment and it is something we are required by law to carry out. This policy lays out the procedures to be adopted by Health Education England and its employees to ensure compliance with the aforementioned legislation. Developing people for health and healthcare Page 2 www.hee.nhs.uk hee.enquiries@nhs.net @NHS_HealthEdEng
Contents Page 1. Introduction 4 2. Purpose 4 3. Scope 4 4. Definitions 4 5. Duties 5 6. Process for Prevention and Management of Slips, Trips and Falls 6 7. Equality Impact Assessment 7 8. Education and Training Requirements 8 9. Monitoring Compliance and Effectiveness 8 10. Associated Documentation 8 11. References 8 Appendices Appendix A Slips and Trips Causation Appendix B Actions to Manage Slips and Trips at Works Appendix C Equality Impact Assessment Appendix D Compliance Monitoring Document Appendix E Procedural Document Check List Appendix F Risk Assessment and Action Plan Developing people for health and healthcare Page 3 www.hee.nhs.uk hee.enquiries@nhs.net @NHS_HealthEdEng
1. Introduction 1.1. The purpose of this document is to enable Health Education England to ensure that it provides a safe working environment free from slip and trip hazards so far as is reasonably practicable. 1.2. Ensuring all potential slip and trip hazards in the workplace are identified. 1.3. Ensuring where necessary the appropriate risk assessments and risk reduction methods are in place at all times regarding slips, trips and falls, especially in relation to staff and contractors who are required to work above ground level and who are at risk of a fall from height. 2. Purpose 2.1. Slips, trips and falls are the most common of workplace hazards and make up over a third of all major injuries. 2.2. Over 10,000 workers suffered serious injury because of a slip or trip last year. Over 2000 of these were within the healthcare sector (Health and Safety Executive (HSE), 2011). 2.3. This policy outlines the duties, responsibilities and procedures that are required within HEE in order to manage the risks associated with slips, trips and falls amongst staff and others. 2.4. These accidents can be cut dramatically through the planning and positive management during new build and refurbishment together with good housekeeping. 2.5. Slips, trips and falls are not an inevitable part of the healthcare industry - they can and should be prevented. 2.6. Everyone in the workplace has a part to play when it comes to preventing slips and trips, from the person who designed the building to the people working inside of it. 3. Scope 3.1. This policy applies to all HEE staff or third parties with whom HEE have a responsibility and a duty of care, and incorporates the processes required for the management of slips, trips and falls. 4. Definitions For the purposes of this policy, the following terms are defined as: 4.1. Slip: To slide accidentally causing the person to lose their balance. This is either corrected or causes a person to fall. 4.2. Trip: To stumble accidentally over an obstacle, causing the person to lose their balance. This is either corrected or causes a person to fall. 4.3. Fall: An event which results in the person coming to rest on the ground or another surface lower than the person, whether or not an injury is sustained. Developing people for health and healthcare Page 4 www.hee.nhs.uk hee.enquiries@nhs.net @NHS_HealthEdEng
5. Duties 5.1. Chief Executive Officer 5.1.1. Shall ensure that the effectiveness of the policy is monitored via the HEE Committee. 5.2. Estates and Facilities Management Lead 5.2.1. Shall ensure that current good practice will be followed when introducing new or refurbished floor surfaces. Appropriate advice and guidance is followed with regard to flooring design, specification, procurement, construction, commissioning, and cleaning and maintenance regimes. 5.2.2. Shall ensure that contractors and sub-contractors are effectively monitored in order to reduce slips and trips hazards which they may create. 5.2.3. Shall ensure where HEE are responsible that roads and pathways are suitably treated during adverse weather conditions (e.g. snow and ice) in accordance with a gritting plan in order to reduce the risk of slips, trips and falls. Where HEE are not responsible then report to the Building Management Team any such defects and ensure that remedial action is instigated. 5.2.4. Shall ensure that an effective planned preventative maintenance programme for repairs to roads/potholes, where HEE is responsible, in order to reduce slips, trips and falls. Where HEE are not responsible then report to the Building Management Team any such defects and ensure that remedial action is instigated. 5.2.5. Shall prior to taking occupation of a building carry out risk assessments on common activities and hazards within the work environment these are then issued to individual sites and placed within the health and safety folder. 5.2.6. Shall ensure appropriate lighting in general areas in order to reduce the risk of individuals misjudging flooring or not seeing contaminants. 5.2.7. Shall ensure appropriate handrails at the recommended height are fitted where required on slopes and stairs. 5.2.8. Shall be responsible for reporting to the HSE any slip, trip and fall incidents in line with the requirements of the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995. 5.2.9. Shall on an annual basis attend each site and undertake an annual health and safety inspection which includes assessing the site, checking all walkways and areas for slip, trip and falls hazards as well as checking all other risk assessment and site inspections. 5.3. Health and Safety Committee 5.3.1. Shall review incident data with a focus to ensure any trends and learning are identified and appropriate action taken. Through review of workplace assessments the committee will also monitor updates of the slips, trips and falls generic risk assessments within HEE. Developing people for health and healthcare Page 5 www.hee.nhs.uk hee.enquiries@nhs.net @NHS_HealthEdEng
5.4. Performance Managers/Staff Representatives 5.4.1. Shall carry out an inspection of their site every three months, which will include checking all walkways and areas for slip, trip and fall hazards. 5.5. Line Managers/Heads of Department 5.5.1. Shall ensure that all staff are made aware of the requirements of the slips, trips and falls policy for staff and others and comply with the safe systems that are contained within it. 5.5.2. Shall ensure that all staff receives the appropriate training, information and instruction to enable them to utilise the appropriate safe systems for managing slips, trips and falls within the workplace. 5.5.3. Shall ensure that an Accident and Incident Report form is completed for every actual fall and near miss occurring on site. These forms must be completed according to HEE Reporting of Accidents and Dangerous Occurrences Policy. 5.5.4. Shall ensure that risk assessments relating to slips trips and falls are completed to cover their areas of responsibility. 5.5.5. Shall ensure that all reported incidents involving slips, trips and falls are investigated and the necessary actions carried out within the agreed timescales. 5.5.6. Shall ensure that appropriate action is taken when workplace inspections or general observation indicates the non-adherence to the required procedure for controlling slips, trips and falls in their area of responsibility. 5.6. Employees Responsibilities 5.6.1. Shall ensure that they undertake their duties in such a manner as not to produce a potentially hazardous situation which may lead to a slip trip or fall. 5.6.2. Shall ensure that if it is safe to do so they clear up any spillage they are responsible for creating, or ensure that the area is made as safe as possible by restricting access to the affected area, by use of appropriate warning signs and or cordons and report the hazard to relevant person/s or department. 5.6.3. Shall ensure that any hazard which may lead to a slip trip or fall is reported to their line manager immediately. 5.6.4. Shall ensure that an Accident and Incident Report form form is completed for every actual fall and near miss occurring on site. These forms must be completed according to HEE Reporting of Accidents and Dangerous Occurrences Policy. 6. Process for Prevention and Management of Slips, Trips and Falls 6.1. Process for Risk Assessment 6.1.1. HEE pro-actively identifies and implements controls to prevent the risk of slips trips and falls (including falls from height) involving staff and others using Developing people for health and healthcare Page 6 www.hee.nhs.uk hee.enquiries@nhs.net @NHS_HealthEdEng
the Health and Safety Executives five steps to risk assessment the following processes are undertaken: 6.1.2. Prior to taking occupation of a building the Estates and Facilities Management Lead will carry out risk assessments on common activities and hazards within the work environment these are then issued to individual sites and placed within the health and safety folder. 6.1.3. All line managers will receive training in how to undertake and complete risk assessments see Section 8 including familiarisation with risk assessments forms. 6.1.4. Line Managers will undertake risk assessments and formulate action plans within the environment following a significant change or following an incident and this will be placed within the health and safety folder. 6.1.5. Performance Managers and/or staff representatives will carry out an inspection of the site every three months, which will include checking all walkways and areas for slip, trip and fall hazards. 6.1.6. On an annual basis the Estates and Facilities Manager will attend each site and undertake an annual health and safety inspection which includes assessing the site, checking all walkways and areas for slip, trip and falls hazards as well as checking all other risk assessment and site inspections. 6.1.7. The slips, trips causation list (Appendix A) and the action chart for slips and trips (Appendix B) will assist managers and risk assessors in identifying hazards associated with a slip and trip risk assessment for their area, which will then be recorded on the generic risk assessment form (Appendix F). 6.1.8. There must be an appropriate action plan developed for each specific risk identified using the above process and this must be implemented in accordance with the requirements of the Integrated Risk Management Policy (Including timescales, lead personnel). 6.2. Process for Incident Reporting 6.2.1. An Accident & Incident Report form must be completed for every incident involving a slip, trip and fall and any near miss incidents occurring on site. 6.2.2. These forms must be completed in accordance with HEE s Reporting of Accidents and dangerous Occurrences Policy. 6.2.3. The Health and Safety Committee will review incident data with a focus to ensure any trends and learning from slips, trips and falls are identified and appropriate action taken. 6.3. Process for Awareness Raising 6.3.1. HEE uses various processes for raising the awareness of slips, trips and falls prevention such as: 6.3.1.1. Induction Training for all staff. 6.3.1.2. Health and Safety Training for Line Managers 6.3.1.3. Accident reports to the Health and Safety Committee 7. Equality Impact Assessment (EIA) 7.1. Under the Equality Act, the need for public bodies in England to undertake or publish an equality impact assessment of their policies, practices and decisions was Developing people for health and healthcare Page 7 www.hee.nhs.uk hee.enquiries@nhs.net @NHS_HealthEdEng
removed in April 2011 when the 'single equality duty' was introduced. Public bodies must still give "due regard" to the need to avoid discrimination and promote equality of opportunity for all protected groups when making policy decisions and are required to publish information showing how they are complying with this duty. 7.2. Please refer to EIA (Appendix 3). 8. Education and Training Requirements 8.1. To help to ensure effective implementation of this policy the Training Needs Analysis (TNA) should be followed. 8.2. All new employees will receive safety awareness training at a mandatory induction training session. No employee will carry out duties that have an obvious health or safety risk e.g. cleaning, estates maintenance etc. until they have received adequate training in understanding the hazards involved and the precautions to be taken in reducing the risk. 8.3. All staff must complete the Mandatory Health and Safety Overview e- learning training package and will be monitored through OLM to ensure compliance This section should identify any education and training requirements related to the effective implementation of the policy, where relevant. 9. Monitoring Compliance and Effectiveness 9.1. To monitor effective compliance with this policy the Compliance Monitoring Matrix at Appendix D must be used. 10. Associated Documentation 10.1. HEE Health and Safety Policy 10.2. HEE Reporting of Accidents and dangerous Occurrences Policy 11. References This s e c t i o n c o n t a i n s t h e e v i d e n c e b a s e a n d d e t a i l s any r e f e r e n c e materials used in the development of this policy 11.1. Health and Safety Executive Working at Height Regulations (2005) amended A brief guide. http://www.hse.gov.uk/pubns/indg401.pdf 11.2. Health and Safety at Work Act 1974 http://www.hse.gov.uk/legislation/hswa.htm 11.3. Management of Health and Safety at Work regulations 1999 http://www.opsi.gov.uk/si/si1999/19993242.htm 11.4. The workplace (Health Safety and Welfare) regulations 1992 http://www.opsi.gov.uk/si/si1992/uksi_19923004_en_1.htm 11.5. Preventing slips and trips at work (HSE) A Brief Guide. Developing people for health and healthcare Page 8 www.hee.nhs.uk hee.enquiries@nhs.net @NHS_HealthEdEng
Appendix A: Slips and Trips Causation What causes slips and trips Slip and trip accidents can happen for a number of reasons, but all too frequently we jump to conclusions about why they happen rather than really looking for the true cause or, we decide that it is just one of those things and do nothing. The diagram below is the slip and trip potential model. The bubbles highlight the main factors that can play a part in contributing to a slip or trip accident. One or more may play a part in any situation or accident. (HSE, 2011) Also listed below are the main causes: A: Slip Hazards Spills and splashes or liquids and solids Wet floors (following cleaning) Unsuitable footwear Rain, sleet and snow, ice Change from a wet to dry surface (footwear still wet) Unsuitable floor surface/covering Dusty floors Sloping surfaces C: Fall Hazards Staff not trained in moving and handling Over reaching Climbing on furniture Rushing down steps/stairs, faulty or unsuitable equipment Ladders Faulty equipment B: Trip Hazards Loose floorboards/tiles Uneven outdoor surfaces Holes/cracks Changes in surface level Cable across walking areas Obstructions Bumps, ridges and protruding nails etc. Electrical and telephone socket outlets D: Factors which Increase Risk Untrained staff Risk assessments not carried out regularly Poor or unsuitable lighting Rushing around Distractions/fatigue Effects of alcohol, Drugs and Medication Page 9
Appendix B Action to Manage Slips and Trips at Work Hazard Suggested Action Spillage of wet and dry substances Clean up spills immediately Bodily fluids Unsuitably trained staff No appropriate risk assessments Miscellaneous items stored or discarded in access routes (broken equipment, chairs etc.) Slippery surfaces Poor lighting Changes of level Slopes Unsuitable footwear Trailing cables Ensure suitable cleaning agents are used. Whenever there is a wet floor after cleaning, use appropriate signs to tell people the floor are still wet and arrange alternative routes. Access to materials as appropriate. Ensure appropriate training to carry out the required duty, i.e. knowledge of cleaning processes and chemicals. Risk assessments should be completed or reviewed at regular intervals, also incidents must be reported and control measures put in place as appropriate. Keep area clear; remove rubbish and do not allow area to build up with equipment, etc. Assess the cause and treat accordingly, with appropriate measures that could include mats, cleaning methods, new flooring etc. Improve lighting levels and placement or light fittings to ensure more even lighting of all floor areas. Improve lighting, consider high visibility tread nosing. Improve visibility, provide handrails, and use floor markings. Ensure employees choose suitable footwear, particularly with the correct type of sole for the work undertaken Position equipment to avoid cables crossing pedestrian routes, use cable covers to securely fix to surfaces, restrict access to prevent contact. Consider use of cordless tools. Remember that contractors will also need to be managed. Rugs/mats Ensure mats are securely fixed and do not have curling edges. Page 10
Appendix C Equality Impact Assessment Assessor Name: Steve Duncan Job Title: Estates and Facilities Manager Identified Service/ Function/ Policy/ Process/ Change Service/ Function/ Policy/ Process/ Change: New Policy Overall aims: The policy provides an overview of HEE s arrangements in place in relation to slips, trips and falls and procedures to be followed. Page 11 Who does the policy/process, service/function or change affect? This policy affects all staff employed within HEE. Screened by: Steve Duncan Initial screening carried out on: 16 July 2013 Relevance of the new development and/or change to each Equality Strands: Degree of Relevance* Race Ensures Equal Access 0 zero Disability Ensures Equal Access 0 zero Gender Ensures Equal Access 0 zero Age Ensures Equal Access 0 zero Sexual Orientation Ensures Equal Access 0 zero Religion/Belief Ensures Equal Access 0 zero Human Rights Ensures Equal Access 0 zero Socio Economic Ensures Equal Access 0 zero Outline the Positive or Negative Impact *KEY: What is the degree of relevance either positive (+ve) or negative (-ve) on a score of 0 3. 0 = None 1 = A little 2 = Some 3 = A lot Summary of data or evidence available and data identified to gather: References Action: (Please delete as The degree of relevance to individual equality strands will not Signed by Manager: Steve Duncan appropriate). require a full Equality Impact Assessment. Date signed: 16.07.2013
Appendix D Compliance Monitoring Matrix Minimum Requirement to be monitored: Who will perform the monitoring? What will you monitor? Set SMART objectives! How are you going to monitor? When will the monitoring be performed? Responsible individual / group / committee for review of results Responsible individual / group / committee for development of action plan Responsible individual / group / committee for monitoring of action plan and implementation Duties are in place for all persons who could be subjected to slips, trips or falls Policy Owner To ensure that all duties outlined within this policy is relevant and allocated to the appropriate role within the organisation Requirement to undertake appropriate risk assessments for the management of slips, trips and falls involving staff and others (including falls from height) Estates and Facilities Manager A sample (5) of general risk assessments undertaken at each NHS Direct site Organisation s expectations in relation to staff training, as identified in the training needs analysis Estates and Facilities Manager/Learning and Development Ensure the training materials used are relevant and contain the most up to date information Review the policy Health and Safety Inspection Review Training Materials Process for raising awareness about preventing and reducing the number of slips, trips and falls involving patients, staff and Others. Estates and Facilities Manager 100% of Incident report completed on Accident & Incident Report Form Review Health and Safety Accident & Incident Report Forms Annually Annually Annually Quarterly Health and Safety Committee Policy Owner Health and Safety Committee Estates and Facilities Manager Estates and Facilities Manager Health and Safety Committee Health and Safety Committee Estates and Facilities Manager/Learning and Development Health and Safety Committee Health and Safety Committee Health and Safety Committee Health and Safety Committee Page 12
Appendix E Procedural Document Check List To be completed by the procedural Document Owners, and attached to all procedural documents when submitted to the Operational Management Executive Committee for monitoring, audit and approval purposes. 1. Title Title of document being reviewed Is the title clear and unambiguous and start with HEE in the title. Is it clear whether the procedural document is a strategy, policy, operating procedure or guidance. 2. Rationale Are the reasons for development of the document clearly stated in the Introduction. 3. Development Process Is the method described in brief. Has the document been developed using the HEE style and format. Do you feel a reasonable attempt has been made to ensure relevant subject matter expertise has been used. Is there evidence of consultation with stakeholders in the version control record. 4. Content Is the objective of the document clear. Is the target population clear and unambiguous. Are the intended outcome described. Are the statements clear and unambiguous. 5. Evidence Base Is the type of evidence to support the document identified explicitly. Has a reasonable attempt been made to explain and define unfamiliar terms. Are supporting references citied in full and in the approved Harvard Style. /No/ Unsure No Comments This document is issued for comment approval by OMEC. Page 13
Title of document being reviewed Are organisational supporting associated documents referenced in the Associated Procedural Documents record. 6. Ratification/Approval Does the document identify which committee/group will approve it. Does the committee have the appropriate power to ratify the document in accordance with its terms of reference. 7. Dissemination and Implementation Is there an outline/implementation plan to identify how this will be done including Training Needs Analysis. Does the plan include the necessary training support/support to ensure compliance. 8. Document Control Does the document identify where it will be held. Have archiving arrangements superseded documents been addressed. 9. Process for Monitoring Compliance Are there measurable standards or KPI s to support monitoring compliance of the document. Where relevant, does this Procedural Document contain the NHS Litigation Authority Level 1 Minimum Requirements. 10. Review Date 11. Is the review date identified and consistent with the HEE Policy on procedural Documents. Overall Responsibility for the Document Is it clear who will be responsible for dissemination implementation and review of the documentation. /No/ Unsure Comments Page 14
Appendix F Health Education England Slips, Trips and Falls Risk Assessment and Action Plan Assessment carried out by: Job Title: Location: Work Activity: Date of Assessment: Review Date: Activity/Task Complete the relevant details of the activity being assessed Significant Hazards All hazards associated to the activity should be entered here: task, individual, load and environment Those at Risk E.g. staff, public and others Current Control Measures List current control Measures With these controls the risk is (circle) Unacceptable Further Controls Required Adequately Controlled Further Control Measures Required List further action needed to adequately control risks Action Required: Date of Completion By Whom Assessor Name: Signature: Date: Page 15