Aide, Ambulatory

Yes

No

Does this employee have direct patient contact?

x

Critical Demands

N/A

0%

Rare

1-5% (Up to a 1/2 hour)

Occa

6-33% (1/2 hour to 3 hours)

Freq

34-66% (3 to 5½ hours)

Cont

67-100% (5½ to 8 hours)

Standing - Remaining on one's feet in an upright position at a work station without moving about.

x

Walking - Moving about on foot.

x

Sitting - Remaining in a seated position.

x

Squatting - Assuming or maintaining a crouching position with the knees bent.

x

Reaching - Stretching out or extending to touch or grasp.

x

Lifting - Raising or lowering an object from one level to another (includes upward pulling).

x

Carrying - Transporting an object, usually holding it in the hands or arms, or on the shoulder.

x

Pushing/Pulling – Exerting force upon an object so that the object moves away/towards from the force.

x

Handling/Fingering – (includes typing, computer work, gripping, grasping, and pinching)

x

Sedentary Work - Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.

Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work.

x

Heavy Work - Exerting 50 to 100 pounds of force occasionally, and/or 25 to 50 pounds of force frequently, and/or 10 to 20 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Medium Work.

Very Heavy Work - Exerting in excess of 100 pounds of force occasionally, and/or in excess of 50 pounds of force frequently, and/or in excess of 20 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Heavy Work.

HAZARD ASSESSMENT FOR PERSONAL PROTECTIVE EQUIPMENT (PPE)

Please contact the employer Employee Health & Safety (EHS) with any questions or assistance related to the completion of the Hazard Assessment for Personal Protective Equipment (HAPPE) Form.

RELATED TO: Hazardous Substances and Harmful Physical Agents

Yes

No

Task Description

Potential Hazard

Hazard control

PPE Required

x

Working with box cutters, knives or other sharp cutting devices.

Penetration

• Cut away from body.

• Use proper tool for the job.

Safety knife or safety box cutter

Cut resistant gloves

Other ___________________

x

Working with liquid chemicals, acids, or caustics (Examples: reprocessing, cleaners, disinfectants, laboratory chemicals).

See MSDS online database for chemical list

Chemicals

Flammables

Toxic Gases

Corrosives

• Use only employer approved products.

• Use appropriate soaking containers with labels.

• Understand hazards of chemicals you use (read MSDS).

Goggles

Chemical face shield

Chemical resistant gloves

Chemical resistant aprons

Lab Coat

Closed toe shoes

Powered Air Purifying Respirator

Other ___________________

x

Exposed to extreme heat (Examples: Autoclaves, Blanket warmers, Ovens, Propane torches) or cold (Liquid Nitrogen, Winter temperatures).

Heat

Cold Stress, Burns, Frostbite

• Approach hot surfaces carefully.

• Use only approved liquid nitrogen dewars. Dispense only if trained.

Heat resistant gloves

Cryogenic (cold resistant) gloves

Goggles

Face shield

Other ___________________

x

Driving or riding in motorized vehicle equipment as part of the job.

Vehicle crash, Impact

• Absolutely no text messaging while driving.

• Refrain from cell phone use while driving.

Seat belt

Other ___________________

x

Working in extremely wet or slippery conditions or working in 24/7 operations where floors are wet from mopping.

Slip, Trip, or Fall

• For wet areas, mop excess water regularly.

• Place warning signs.

• Select footwear carefully

Slip resistant shoes

Rubber boots

Other ___________________

x

Preparing or handling hazardous drugs (Examples: cytotoxic drugs, chemotherapy agents).

Chemical

Genetic damage

Tumors

• Receive training

• PPE

• Use of biological cabinet

• Spill procedures

• Waste disposal SOP

Gloves appropriate for chemical

Disposable barrier gown

Goggles

N95/PAPR (spill cleanup)

Ventilation Hood

Other ___________________

x

Medical/surgical procedures involving heat generating tools or equipment (Examples: cautery/ lasers).

Light radiation, burns to self or patient, smoke inhalation

• Receive laser training.

• Awareness and knowledge to minimize surgical or procedural fires.

• Code Red training

• PPE

• Restricted access

Specialized laser safety glasses

Other ___________________

x

Working with or near ionizing Radiation Hazards (Examples: Radioactive sources, X-Rays).

Over exposure, Genetic damage

• Warning signage

• PPE

• Waste and spill procedures

• Personal monitoring

• Shielding, distance

Lead Aprons

Other ___________________

x

Working near MRI.

Trauma resulting from missile effect

• Restrict access

• Screening

• Signage

x

Moving equipment/supplies.

Strain, Sprain

• Proper body mechanics

• Get additional help

• Get Ergonomic help from EOHS.

x

Dealing with agitated persons or disturbances.

Workplace violence, bodily injury, body fluid exposure

• Training in verbal de-escalation techniques.

• Code Green procedure

Gloves (Clean)

Barrier Gown or fluid resistant Lab Coat

HAZARD ASSESSMENT FOR PERSONAL PROTECTIVE EQUIPMENT (PPE)

RELATED TO: Infectious Agents

Yes

No

Description

Potential Hazard

Hazard control

PPE Required

PERFORMING OR ASSISTING WITH THESE TASKS:

x

Potential for splash of blood/body fluid to face and clothing: examples but not all inclusive: suctioning, wound irrigation, eye & ear irrigation, close contact (within 3 ft.) of patient with frequent, productive cough, sigmoidoscopy, cystoscopy, colonoscopy.

Exposure to Infectious Agents

• Hand hygiene before and after task

• PPE

Facial protection (mask plus goggles OR face shield)

Gloves (Clean)

Barrier Gown if anticipate splash

x

Activity that requires touching patient’s non-intact skin or mucous membranes.

Exposure to Infectious Agents

• Hand hygiene before and after task

• PPE

Gloves (Clean)

x

Activity that includes touching patient’s blood/body fluid or contaminated items or environment, examples, but not all inclusive: disposal of urine, blood canisters.

Exposure to Infectious Agents

• Hand hygiene before and after task

• PPE

• Use of Spill kits (as needed)

Gloves (Clean)

Barrier Gown if anticipate splash

Facial protection (mask plus goggles OR face shield) if anticipate splash

x

Performing duties with sharp devices that could result in exposure to blood or body fluids.

Exposure to Infectious Agent/sharp injury

• Use of sharps safety devices

• Avoid re-capping needles

• Proper disposal of sharps at point of care

• For reusable sharp, use safe transporting practices

• Use neutral zone for passing sharps

• PPE

Gloves (Clean vs. Sterile depends on the procedure)

Facial protection (mask plus goggles OR face shield) if anticipate splash

x

Entering rooms where patients with airborne diseases are treated.

Exposure to Infectious Agent/inhalation

• Mask patient

• Place patient in airborne infection isolation room if available

• Limit entry into room

• Keep door closed

• PPE

Follow Communicable Disease Guidelines and Tuberculosis Control Plan to determine if N95 respirator, PAPR, or surgical mask is needed

x

Work with specimens from patients with airborne diseases.

Exposure to Infectious Agent/inhalation

• PPE

• Biological Safety hoods/cabinet instrumentation with automated/closed sampling mechanisms

N95 respirator or PAPR

x

1. P rocedures that enter deep tissue or body fluid, including but not limited to :

Central IV insertion, placing a catheter or injecting material into the spinal canal or subdural space (myelogram, lumbar puncture, spinal/epidural anesthesia), breast biopsy, temporal artery biopsy, bone marrow biopsy, OB vaginal delivery, incision & drainage.

Exposure to infectious agents

• Hand hygiene before and after procedures

• PPE

Gloves (Sterile)

Barrier Gown

Facial protection (mask plus eye protection or face shield plus mask required during these procedures)

x

2. a. Procedures that enter

subcutaneous tissue or are located

in the skin structure, including but

not limited to:

• Excision of mole, lump, or bump

• Excision of lipoma or sebaceous cyst, vasectomy

Exposure to infectious agents

• Hand hygiene before and after procedure

• PPE

Facial protection (mask and eye protection required during these procedures if anticipate splash)

Gloves (Sterile)

Barrier Gown if anticipate splash

x

2. b. Additional Procedures

• Shave biopsy, punch biopsy

• Joint injection, nerve injection, joint aspiration

• Peripheral IV insertion, ENT procedures

• Anal-rectal Biopsy

Exposure to infectious agents

• Hand hygiene before and after procedure

• PPE

Gloves (Clean)

Barrier Gown if anticipate splash

Facial protection (mask and eye protection required during these procedures if anticipate splash)

x

3. Handling Lab specimens in a laboratory

Exposure to infectious agents

• Hand hygiene after removing gloves

• PPE

• Biological Safety hoods/cabinet

• Splash guard

• Instrumentation with automated/closed sampling mechanisms

Lab Coat ( fluid resistant)

Gloves (Clean)

Facial protection (mask plus eye protection or face shield plus mask required during these procedures)

Other tasks with identified safety, health or infectious hazards requiring PPE?

Yes

No

Task Description

Hazard

Hazard control

List PPE required

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