The Activity Based Risk Assessment Form Mom is a critical workplace safety document required under Indonesian law to protect the health and safety of pregnant and nursing employees in the workplace. This document is necessary whenever pregnant or nursing employees are present in the workplace or when planning work activities that may involve such employees. It aligns with Indonesian regulations, particularly Law No. 1 of 1970 on Occupational Safety and Law No. 13 of 2003 on Manpower, which mandate specific protections for maternal health in the workplace. The form encompasses comprehensive risk evaluation, including hazard identification, risk assessment, control measures, and monitoring protocols specific to maternal health considerations. It should be completed before commencing new work activities or when significant changes occur in the workplace that could affect maternal health.
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1. Document Information: Basic information including date, location, department, and assessor details
2. Activity Description: Detailed description of the work activity being assessed, including duration and frequency
3. Persons at Risk: Identification of pregnant/nursing workers and others who may be affected by the activity
4. Current Control Measures: Existing safety measures and protocols already in place
5. Hazard Identification: Systematic identification of all potential hazards related to the activity
6. Risk Assessment Matrix: Evaluation of likelihood and severity of identified risks using standardized scoring
7. Additional Control Measures: New or enhanced control measures required to minimize identified risks
8. Action Plan: Detailed implementation plan for recommended control measures including responsibilities and timelines
9. Review and Sign-off: Approval section including signatures from assessor, supervisor, and health & safety representative
1. Emergency Procedures: Specific emergency response procedures - include when activities involve high-risk operations or remote locations
2. Medical Considerations: Specific medical requirements or restrictions - include when activity requires medical clearance or monitoring
3. Equipment Requirements: Detailed list of required PPE and equipment - include for technical or specialized activities
4. Training Requirements: Specific training needs - include when activity requires special certifications or skills
5. Environmental Factors: Assessment of environmental conditions - include for outdoor activities or temperature-sensitive environments
1. Risk Assessment Matrix Template: Standard template for risk scoring and evaluation
2. Hazard Checklist: Comprehensive checklist of potential hazards specific to maternal health considerations
3. Control Measures Register: Detailed list of recommended control measures and their implementation status
4. PPE Requirements Chart: Visual guide showing required personal protective equipment
5. Emergency Contact Information: List of relevant emergency contacts and procedures
6. Review Schedule: Timeline for periodic review and updates of the risk assessment
Authors
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Manufacturing
Office and Administrative
Education
Retail
Hospitality
Public Services
Financial Services
Technology
Research and Development
Pharmaceutical
Food and Beverage
Relevant Teams
Occupational Health and Safety
Human Resources
Risk Management
Operations
Medical Services
Facilities Management
Employee Relations
Compliance
Environmental Health
Quality Assurance
Relevant Roles
Occupational Health and Safety Manager
Risk Assessment Specialist
Human Resources Director
Workplace Safety Coordinator
Environmental Health Officer
Industrial Hygienist
Department Manager
Safety Compliance Officer
Occupational Health Nurse
Facility Manager
Operations Manager
Medical Officer
Employee Relations Manager
Health and Safety Consultant
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