Health and Safety Guide to Working in Isolation in the Health and Disability Sector A guide for employers 311063-ACC5259-Pr04.indd 1 5/03/10 1:06 PM
Purpose This document has been developed by the Health and Disability Sector Safer Industry Forum group with the assistance of ACC. Its purpose is to provide guidance for employers and managers in identifying, assessing and controlling the hazards that are associated with working in isolation. This guide will also assist with the development of appropriate policies and procedures to enable organisations to meet their legal obligations. Scope This document is relevant for all healthcare employers and their employees who are required to work in isolation as part of their duties. Supporting this document is a one-page checklist for employees. A copy has been included at the end of this booklet for you to photocopy. If you want to download a copy for your staff, go to www.acc.co.nz and search ACC5260. 1
What is Working in Isolation? Working in isolation can be defined as: Working alone or remote from normal services and support, limiting capacity to summon assistance readily in the event of injury, illness, violence, emergency or other event, and therefore increasing the risk of harm. A lone worker is: A worker whose activities involve a large percentage of their working time operating in situations without the benefit of interaction with other workers or without supervision or collegial interaction. Employees may work in isolation if they: Physically work alone, for example at night in a laboratory Work separately from others, for example community nurses Work at home, for example researchers Work outside normal hours, for example on-call maintenance staff Work shift work or night work, for example security staff Travel as part of work, for example social workers Provide home-based care, for example home-based support workers Work unsupervised, for example night staff Work in geographical isolation, for example in a remote part of the countryside Work on a reduced staff roster, for example on public holidays Work in a situation of emotional isolation, for example a new, young or inexperienced worker in a new position. It might also include cultural and gender isolation, such as someone from a minority culture/ethnicity working in a mainstream organisation, or working in a profession with a gender majority, for example male caregivers. 2
Health and Safety Responsibilities The Health and Safety in Employment Act, 1992 (HSE Act) sets down responsibilities and obligations to ensure safety, and health and wellbeing, while at work. Employer responsibilities Employers must take all practicable steps to ensure the safety of employees at work, and in the case of lone workers they should: Establish if lone working is necessary, and identify the hazards and appropriate management options Use hazard identification and risk assessment processes to help determine the level of supervision required Engage with their employees and work together to decide what level of support and assistance is required. This might include: Consulting staff groups and their unions about health and safety management systems Providing employee support systems, including appropriate training Ensuring that employees understand the risks associated with their work and that the necessary safety precautions are taken Supervisors providing guidance in situations where the risks of working in isolation are unclear Supervisors making periodic site visits and addressing health and safety issues that arise. If recommendations for improvements or corrective actions are made, these should be carried out within a reasonable timeframe. Employee responsibilities Employees must take all practicable steps to ensure their own safety, and that no action or inaction causes harm to others. This means that if they are lone workers they should be trained so that they know they should: Take reasonable care to look after their health and safety while at work, which could include reporting unexpected fatigue, feeling compromised, or requiring additional support Report and, if reasonably practicable and they are sufficiently skilled to do so, rectify identified hazards. Reporting hazards should be done as soon as is practicable, for example by contacting someone directly, through a handover book or during the handover time at work 3
Comply with any workplace safety and health procedures, for example use materials and equipment safely as per instructions. If in doubt, they should ask Ensure that safety processes remain operational Report all accidents and incidents, including any problems with procedures that are in place and are not practicable for the lone workers to rectify. Role of the elected and trained health and safety representative Health and safety representatives have a very important role in representing lone workers and issues surrounding working in isolation. Their role may entail: Helping to facilitate regular evaluations of the necessity of lone working, in the first instance Contributing to the development of safe systems of work Advising on safe work practices Representing any suggestions from the lone workers to the employer If required, issuing hazard notices as per the HSE Act. 4
Hazard Identification, Risk Assessment and Hazard Control Hazards should be identified, risks assessed and controls put in place. In the case of working in isolation, hazards, assessments and controls may differ from what normally occurs. Remember, working in isolation isn t necessarily working alone! Step One: Identify the hazards Work-related injuries and diseases can arise from hazards at work. Hazard identification and risk assessment should be carried out and appropriate controls implemented to eliminate, isolate or minimise hazards. Determine if the hazards are significant (as outlined in the HSE Act). Hazards may include: The design of the work processes The materials, substances and equipment being used Physical hazards such as noise and exposure to infection The organisation of the work Factors such as stress, emotional isolation, workload or lack of instruction or training. Working in isolation is a hazard that may increase or alter the risks associated with other hazards. Below are examples of hazards that might be further compounded by working in isolation. Accidents and emergencies arising out of the work, and the provision (or lack of it) of first aid treatment Sudden illness or incapacity Inadequacy of rest, hygiene and welfare facilities Physical violence from members of the public and/or intruders Physical demands of the work, for example lifting or carrying Mental demands of the work, for example is the work monotonous, repetitive or is there a need for high vigilance and concentration, which means the risks may be increased by working in isolation? The hours of work, for example night shifts, length of shifts, breaks Physical or professional limitations specific to employees and/or the work 5
Personal needs and work experiences of the employee, such as: Contributory factors Pregnant employees Migrant workers with issues with language, cultural barriers and training Pre-existing medical, physical or mental health problems The emotional state of employees People who rely on public transport to get to and from work Special circumstances on the site, for example geographical location. Step Two: Assess the risks Risk assessment To address hazards identified with lone working, a risk assessment must be carried out. Risk assessment is a process of identifying what hazards exist in the workplace and how likely it is that they will cause harm or serious harm to employees and others. It is the first step in deciding what prevention or control measures employers need to take to protect their employees from harm. Good risk assessment is the key to maximising safety wherever work in isolation is occurring. It should address two main features (in addition to the risk the hazard poses): Whether the work can be done safely in isolation Whether there are adequate arrangements to ensure the lone worker is safe. Risk assessments should use all available information, including details from accident records and consultation with the health and safety representatives and safety managers. The risk assessment should include arrangements for systematic monitoring of the hazards associated with working in isolation, and should be updated regularly, as and when processes, staff and work methods change. It should identify the preventative and protective measures needed (as far as is reasonably practicable). Managers should identify situations where people may work in isolation and ask questions such as: Is there safe access and egress? Can all equipment, substances and loads involved in the work be safely handled by one person? Is there a risk of violence? Are women especially at risk if they work alone? Are young workers especially at risk if they work alone? Medical suitability? Does working in isolation impose any extra demands on the lone worker s physical or mental abilities or professional responsibilities? 6
Does the lone worker suffer from any illness or injury that might increase the risks associated with working in isolation? Has there been a discussion between the employer and the employee about their capability? If home working, have a hazard identification and risk assessment of the job and the workplace been carried out? Staffing levels: Can the job be done safely by a single person? The manager should ensure that any additional hazards or risks to which the lone worker is exposed are managed and controlled adequately. Step Three: Control the hazards Controlling the hazards associated with working in isolation may require extra hazard control measures. Precautions should take account of normal work and foreseeable emergencies, for example fire, equipment failure, illness and accidents. Procedures will need to be put in place to monitor isolated workers to see they remain safe. Hazard controls may include: Emergency procedures Emergency procedures, including in the event of serious and imminent danger, should be established and employees trained in their use. Information about emergency procedures and danger areas should be provided to isolated workers. Supervision Supervisors should periodically visit and observe people working in isolation and appoint competent people to assist the isolated workers. Personal protective equipment Where a hazard cannot be eliminated or isolated, provision of and training in the use of personal protective equipment (PPE) may be appropriate. First aid Isolated workers should have ready access to first aid equipment and facilities at all times. Risk assessment may indicate that the employee needs training in first aid, for example where there is no access to a qualified first aider. If the employee is not trained in first aid, adequate procedures need to be put in place in case of an accident. Communications and personal alarms Appropriate communication and regular contact between the isolated worker and supervision may be provided by using either a telephone or a radio. There are also automatic warning devices available that operate if specific signals are not received periodically from the lone worker, or devices that are activated automatically by the absence of activity. Establish procedures to verify that a lone worker has returned to their base or home on completion of a task. 7
8 Preventing violence Establish procedures to minimise the risk of violence from the public, for example: The elimination of handling drugs/cash Changes of route or timing when transporting valuables/medication, or when doing routine and scheduled visits Adequate building security for out-of-hours working Give consideration to particular groups of employees such as women or young/ inexperienced staff Provide training, for example in non-violent intervention, if appropriate Liaise with community services, for example the Police. Conditions of the workplace Appropriate conditions include: A safe, accessible means of entry to and exit from the workplace Adequate lighting, heating and ventilation for the job to be carried out All equipment able to be used safely and regularly inspected Manual handling operations able to be performed safely by one person For home visits, the premises should be assessed by qualified staff before visits commence. Information and training Sufficient training and information must be provided to isolated workers to enable them to identify hazards and take appropriate action to avoid harm. They must be able to leave the workplace if there is serious and imminent danger. Isolated workers need to be made aware of the risks, and controls should clearly define the limits of work that can be carried out while working alone. Permits to work These are detailed, written instructions provided by the employer. They cover the performance of hazardous activities, such as entry into confined spaces or electrical testing. They should specify: Check-in arrangements Tests of communications equipment Length of work periods Suitable first aid equipment Equipment, tools and electrical safety checks Suitable PPE Suitable manual handling information Arrangements in bad weather
Exit to safety after job completion Emergency procedures and emergency teams. Working in geographically remote or isolated areas For an isolated worker at a remote location, consider: The length of time the work should take and how frequently the worker should report in Travel to and from the location of work, especially out of normal hours Access to adequate rest, hygiene, refreshment and first aid facilities Access for emergency services to the location without hindrance Procedures for responding to emergencies. 9
10
A guide for your staff working by themselves in the health industry What should I do to help keep myself safe? Here is a checklist you can use when you need to work in isolation. Ask yourself each of the questions, and if you don t know the answer, check with your supervisor. An example of a checklist for people working by themselves Do I know? Do I know? Do I have? What are hazards in my job? Note that these can be hazards that result in immediate effects such as an injury, but can also be chronic, i.e., the effects might be disease that may not be evident for some time. How to report hazards to my supervisor? Some events may need to be reported immediately (no matter what the time of day or night) and others can be reported later. How to escalate a safety concern that is not being addressed? What to do in an emergency? For example, telephone numbers and people to contact. Enough about first aid? Is there a person available or have I been trained to meet the minimum requirements that can be reasonably predicted? How to lift or carry safely? There are approved procedures available using equipment and techniques. How to deal with angry or violent people? Has this been part of training so that I can avoid this situation? How often to check in with someone at work? Who to check in with at work? What controls (if any) are in place to reduce the risk of injury from chemicals/liquids? A first aid kit equipped with enough supplies to meet any anticipated or potential need that may arise? The right personal protective equipment (PPE)? The type of PPE will probably include RPE (respiratory protective equipment). Also have I been fit tested to ensure that the RPE works as intended? Access to current information and training? A personal alarm or cell phone so I can keep in touch regularly? Have the important contact people and numbers pre-programmed into the machine. ACC5260 This checklist should be used in conjunction with the employers Health and Safety Guide to Working in Isolation in the Health and Disability Sector (ACC5259). Also available is the resource Guidelines for the provision of facilities and general safety and health in the healthcare industry available from the Department of Labour website (www.dol.govt.nz). Go to www.acc.co.nz to order additional copies of this form. 11
12 Notes
For further information www.acc.co.nz/dpi www.habitatwork.co.nz www.dol.govt.nz
ACC5259 Printed February 2010 ISBN:978-0-478-31464-9 www.acc.co.nz 0800 844 657