Slips, trips and falls for staff and visitors, prevention and management policy

1 Introduction

Slips and trips resulting in falls are the most common cause of serious injuries in Great Britain. Over a third of all accidents to staff that are reportable to the health and safety executive (HSE) under the Reporting of Injuries Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) are as a result of slips, trips and falls.

Rotherham, Doncaster and South Humber NHS Foundation Trust (hereafter referred to as the trust) will take all reasonably practicable measures to ensure that workplaces under their control are safe and without unnecessary risks of slips, trips and falls to all persons needing to access them.

The Management of Health and Safety at Work Regulations 1999, in accordance with the Health and Safety at Work Act 1974 include duties for people to control workplaces and to assess the risks (including slips, trips and falls) associated with workplace environments. The regulations require appropriate arrangements for effective planning, organisation, control, monitoring and review of any measures used to safeguard health and safety.

The Workplace (Health, Safety and Welfare) Regulations 1992 also require floors and surfaces to be suitable for purpose, in good condition and free of obstructions.

2 Purpose

The purpose of this policy is to provide information and guidance on the management of risks associated with slips, trips and falls, including:

identifying and removing, where possible, all potential slip, trip and fall hazards in the workplace
carrying out a risk assessment and establishing adequate controls to minimise the level of risk

3 Scope

The policy applies to all trust staff, bank and agency staff, volunteers and contractors working in any part of the trust or in partner organisations’ premises. It describes the procedures, which should be followed and the factors, which should be taken into account by all trust managers and staff when dealing with slips, trips and falls in the workplace.

Some of the activities associated with the management of slips, trips and falls overlap with those of other policies and procedures. Specific regulations and guidance cover the hazards of these other activities and the precautions to be taken in relation to these. It is not the intention of this policy to provide details of the overlapping regulations and guidance or the related hazards and precautions to be taken.

The patient falls prevention and management policy addresses slips, trips and falls management involving trust patients. Guidance on safe working at height may be found in the trust’s safe working at height policy.

The trust’s management and control of contractors policy provides information about reducing the risks of slips, trips and falls associated with work carried out by contractors.

4 Responsibilities, accountabilities and duties

4.1 Chief executive

The chief executive has specific accountability to ensure that responsibilities for health and safety, including the management of slips, trips and falls is effectively assigned, accepted and managed at all levels in the trust consistent with good practice. This duty is delegated to others in the trust.

4.2 Trust board of directors

The trust board of directors has delegated responsibility for the management of health and safety, including the management of slips, trips and falls and to ensure this policy is implemented throughout the trust. This is further delegated to managers and supervisors.

4.3 Head of estates and facilities

The head of estates and facilities has responsibility for ensuring that premises in the control of the trust are safe and do not present a hazard to trust staff and others using the premises. This includes safe maintenance of trust premises to reduce the risk of injury from slips, trips and falls.

It is the responsibility of the head of estates and facilities to ensure that contractors work in an agreed safe manner which avoids creating slip, trip and fall hazards which may pose a risk both to themselves and others.

Suitable methods of cleaning premises must be used that do not create additional risks. Some of the above duties are delegated to other managers in Estates and Facilities teams.

4.4 Health and safety lead or Health and Safety team

The health and safety lead or Health and Safety team will assist the trust in undertaking the measures needed to comply with relevant statutory provisions as required by the Health and Safety at Work Act and the Management of Health and Safety Regulations. This will include the provision of relevant health and safety information and advice and review of this policy.

4.5 Managers or supervisors

Managers and supervisors have specific responsibilities to ensure that:

this policy is implemented within their area of control and it is brought to the attention of staff during local induction
risk assessments are completed which encompass the hazards and risks associated with slips, trips and falls. Staff for whom they are responsible must be made aware of any control measures resulting from risk assessments
monitoring of the effectiveness of existing controls is carried out and any further measures agreed as a result of risk assessments are implemented
include inspection of the workplace with the trust Safety team inspection regime
all accidents and incidents involving slips, trips and falls are thoroughly investigated and use any reports of near misses to determine and address potential hazards and risks
spillages and leaks and other defects which may result in a slip, trip or fall are promptly addressed, reported and the area made safe
all staff within their department receive suitable information and training on slips, trips and falls prevention
they enforce the trust uniform and appearance at work or dress code policy so that suitable clothing and footwear is worn that will not result in a slip, trip or fall
any defects to the workplace requiring repair or corrective action are reported to estates and a request made for the corrective action to be taken. If required, action should be taken to safeguard the area immediately in order to prevent further accidents

4.6 Staff

All staff have a responsibility to make themselves aware of this policy. Any slip and trip hazards that they become aware of should be reported to their manager. Staff should also take steps to reduce the risks, such as keeping all areas tidy and removing any obvious trip hazards. All accidents or near misses that occur as a result of a slip, trip or fall must be reported via the trust’s incident reporting system, available through the trust intranet site.

All staff are required by their contract of employment to co-operate with the trust on health and safety matters and compliance with the statutory duty to take reasonable care for the Health and Safety of themselves and others who may be affected by their acts or omissions at work. This includes compliance with this policy and all other trust health and safety policies. Any action to the contrary may result in disciplinary action or legal action under the Health and Safety at Work Act 1974.

5 Procedure or implementation

5.1 Risk assessment and control

A risk assessment must be carried out that identifies the potential factors or hazards that may cause a slip, trip or fall. Action should then be taken to remove the risk, where possible, or to reduce or control the risk, where it is not possible to totally remove it.

Common hazards include (the list is not exhaustive):

slippery surfaces due to contamination with liquids (including bodily fluids), powders or dust
contamination with spilt food products, particularly in kitchen areas.
poor lighting
footwear that is not suitable for the task being carried out
obstructions, such as trailing cables or items temporarily stored in walkways
changes in floor level that are not clearly marked, for example, stair edges
uneven surfaces

Other causes include human factors such as employees rushing, running or carrying heavy or cumbersome items that may obscure their vision so that they are unable to see obstacles.

Possible methods of risk reduction are:

having effective arrangements for both routine cleaning and cleaning up spills
remove spillages promptly
leave smooth floors dry after cleaning or exclude pedestrians until is floor is dry
use the correct cleaning methods for the type of floor
look out for trip hazards and remove or report these
keep walkways and work areas clear of obstructions
encourage staff to keep the workplace tidy
consider the use of slip resistant flooring material

Appendix A gives examples of how to assess and control the hazards and risks associated with slips, trips and falls.

5.2 Accident reporting

Slips, trips and falls incidents and near misses must be reported using the trust’s safeguard incident reporting system, which can be accessed via the staff intranet site.

As incidents caused by a slip, trip or fall often result in serious injury there may be a need to make a report to the HSE under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013.

Further information about how to report an incident can be found in the trust’s incident management policy.

6 Training implications

6.1 All staff

How often should this be undertaken: One off issue at induction.
Delivery method: Leaflet.
Training delivered by whom: Issued by learning and development service.
Where are the records of attendance held: Electronic staff record system (ESR).

A falls assessment course is available for staff who visit patients at home, but this is a requirement under the patient falls prevention and management policy in relation to patient risks of falling.

As a trust policy, all staff need to be aware of the key points that the policy covers. Staff can be made aware through:

staff intranet
team meetings
trust wide emails
trust induction
mandatory training
local induction posters

7 Monitoring arrangements

7.1 Staff slip, trip and falls incident reporting

How: Safeguard IR1 reports or data.
Who by: Health, safety and security forum.
Reported to: Quality committee.
Frequency: Quarterly.

7.2 Assessment of risk

How: Inspections or audit or risk assessments.
Who by: Safety team, managers.
Reported to: Health, safety and security forum.
Frequency: Quarterly.

7.3 percentage of staff uptake of training

How: ESR data.
Who by: Learning and development.
Reported to: Health, safety and security forum.
Frequency: Quarterly.

8 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

8.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

No issues have been identified in relation to this policy.

8.2 Mental Capacity Act 2005

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

8.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005) (section 1).

9 Links to any associated documents

10 References

Management of Health and Safety at Work Regulations 1999.
Workplace (Health, Safety and Welfare) Regulations 1992 (opens in new window).
Work at Height Regulations 2005.
Reporting of Injuries, Disease and Dangerous Occurrences Regulations 2013.
Slips and trips e-learning Package, HSE.
Slips and trips: The importance of floor cleaning. HSE Information Sheet 09/05.
Preventing slips and trips at work, A brief guide, leaflet INDG225 (rev2), 11/12.
Slips and Trips: Guidance for the food processing industry, HSE Books (HSG 156) (ISBN-13:978-0717608324) (1996).
Assessing the slip resistance of flooring. HSE Technical Information Sheet 03/07.

11 Appendices

11.1 Appendix A Slips trips and falls risk controls

Environmental factors
Causative factors	Practical control measures
Contamination of the floor from: spillages of solid or liquid materials wet cleaning methods footwear or clothing natural contamination such as water, and, or mud in outside areas dry contamination, for example dusts, powders, polythene bags left on floors, product spillages or cardboard laid over spills wind-driven rain, sleet and snow through doorways condensation, for example, from poor ventilation	Eliminate contamination in the first place: maintain equipment to prevent leakage install suitable entrance matting systems place entrances to suit the prevailing weather (only an option during the initial design of the building) put up effective entrance canopies If not reasonably practicable, prevent contamination becoming deposited on walking surfaces: use dry methods for cleaning floors clean and dry contaminated footwear, by use of suitable entrance matting If not reasonably practicable, limit the effects of contamination: by immediate clearing up of spillages by prompt repair of leaks by limiting the area of contamination by restricting access to contaminated areas by using under floor heating, particularly at entrances If there is still a risk, follow the next steps.
Inherent slip resistance of the floor not maintained adequately, for example, from incorrect or inadequate cleaning, maintenance or wear	Maximise the surface roughness and therefore slip resistance of the existing floor surface Methods of cleaning and cleanliness of flooring is an important factor to consider, in conjunction with slip resistance. The frequency of cleaning will be determined by how many and the type of persons who will use the floor. Floor manufacturers are required to provide information on the cleaning regime needed to make their floor safe in the intended environment and this information should be passed to the appropriate employees. Just a tiny amount of contamination, wet or dry, is sufficient to make a smooth floor dangerously slippery. Take the following measures minimise the risks due to wet cleaning: thoroughly dry the wet floor after cleaning exclude people from wet cleaning areas until dry clean by dry methods wherever possible clean in sections so that there is always a dry path through the area clean during quiet hours thoroughly rinse wet cleaning areas use warning signs to identify contaminated floors or floors after cleaning spot cleaning and cleaning of spillage will be need between scheduled whole-floor cleaning (and it is equally important to thoroughly dry these areas). Frequent spot cleaning can supplement whole-floor cleaning train, supervise and equip those who clean floors to ensure effective and safe cleaning maintain floors and drainage to maximise slip resistance. A residual film of water is just as slippery as a puddle, and is more difficult to identify If this is not enough, take the following steps.
The Slip resistance of the floor is too low This is influenced by: the friction between the floor and footwear the presence of suitable surface micro-roughness the hardness of the floor applications for sealing floors during installation later modification of the floor surface such as inappropriate varnishing or sealing or polishing	Increase the surface roughness of the existing floor Surface micro-roughness may be increased by acid etching, sand blasting, or coarse diamond grinding. However, any of these methods can destroy or permanently alter other desirable characteristics of the floor such as appearance, chemical resistance, durability and ease of cleaning. Flooring treated by some of these methods may develop unacceptable pattern staining affected, compromising the floor construction Note, any benefits from an increase in the surface roughness (RZ) will be lost if contamination built-up occurs. Therefore any surface modification has implications for the cleaning regime. Changes in cleaning methods must be based on a risk assessment that considers any potential change of slip resistance The use of stick-on anti-strips may offer limited improvement, but strips should be placed very close to one another, and should be maintained carefully If it is possible to influence employee footwear, then anti-slip footwear may be an option (see below). If this is not enough, lay a more slip-resistant floor with higher surface roughness and higher coefficient of friction In a few cases a new floor may be needed: draw up a performance specification for the supplier to meet. Specification should include specialist slip resistance data such as surface micro-roughness and coefficient of friction measurements Note, this data must always be specified for the ‘as installed’ condition, and should be based on a ‘pendulum-type’ test. Experience of how that floor performs in a similar situation may help and a small sample of the preferred materials will confirm manufacturer’s claims and their suitability see the installation is correctly done check to see the specification has been met
Steps and slopes, do they cause sudden changes in height or not offer adequate foothold and, or handhold?	Check that steps give adequate foot and handhold, and that slopes have no sudden changes: is the lighting adequate? are handrails in place? are stairs clearly demarked visually? remove all sudden changes in level ensure stairs have clearly visible musings, good handrails, and suitable balustrades ensure that the rise and going of each step in the stair is consistent in size throughout of the flight ensure that any applied slip-resistant nosing does not create a tripping or heel-catch hazard good visual cues for changes in floor level and surface are essential
Adverse environmental and other conditions hiding the condition of the floor and distracting attention: low light levels shadows glare excess noise extremes of temperature the use of repeating patterns on floor coverings that might be distracting to the eye, for example, by disguising a change in level bulky or awkward personal protective equipment	See that the prevailing conditions allow good visibility of and concentration on floor conditions. For example provide adequate lighting, and see environmental demands do not distract attention from the floor condition.

Organisational factors
Causative factors	Practical control measures
The nature of the task being carried out such as: the need to carry, lift, push, lower or pull loads the need to turn, to move quickly or to take long strides distractions having no hands free to hold on to handrails to stop a fall encumbrance or restricted vision	Analyse the tasks in any slip risk area to see that only careful walking is required Tasks should not compromise ability to walk safely. Tasks should be: mechanised to avoid the need for pushing, lifting, carrying, pulling etc. while walking on a slippery surface loads should not obscure vision of the route of travel ensure routes of travel are not obstructed

Individual factors
Causative factors	Practical control measures
Individual capability poor knowledge of risks and measures poor attitude to health and safety poor eyesight fatigue physical frailty or disability inadequate supervision safety culture which is not supportive, for example where the risks are accepted as part of the job	Allocate tasks in high slip risks areas only to those competent to follow slips precautions. Supervise and monitor physical controls to see safe practices are followed. Establish a positive attitude that slips risks can be controlled. Give consideration to disability and consider whether additional adaptations are needed. This is achieved through clear line management responsibilities, supervision and consultation with workers.

Personal protective equipment, footwear factors
Causative factors	Practical control measures
Footwear can offer insufficient slip resistance in combination with the floor surface, because of: contamination of footwear sole material sole pattern type of footwear wear and tear fit maintenance or replacement	Base this on experience and information or advice from suppliers. Ensure employees maintain issued footwear soles in good repair and keep them free from contamination. Replace them before they have worn smooth.

Individual factors
Causative factors	Practical control measures
Unsafe action by employees, due to: lack of awareness of risk lack of knowledge of how slips occur poor information and training, or distraction, carelessness	Train, inform and supervise employees on the risk, the control arrangements and employees’ role(s) especially to: clean as they go report contamination maintain footwear walk appropriately to circumstances Set Procedures for visitors

Trip risk controls
Causative factors	Practical control measures
Uneven surfaces For example gulley’s, holes, steps, car parks, walkways or paths to premises, flooring within premisesObstructions, for example accumulation of articles such as trolleys, wheelchairs, medical equipment, waste, trailing cables, floor sockets etc. Adverse environment For example inadequate illumination to see floor properly, or glare.	Eliminate holes, slopes or uneven surfaces which could cause trips risks. To do this, inspect and maintain floors so they have a consistent surface finish with no holes or damage that could cause a trip hazard. Highlight any changes in level, particularly at single steps and at the top and bottom of ramps. Make slopes gradual and steps clearly visible, avoid open gulley’s and channels. Eliminate materials likely to obstruct walkways and therefore lead to trips For example analyse work flows and design processes so that waste and equipment does not accumulate on walkways. Or if this is not reasonably practicable, prevent material obstructing walkways For example provide sufficient suitable receptacles for the items, mark out walkways, working areas and receptacle locations and make sure they are kept free of obstruction and provide suitable lighting to permit obstructions to be seen

Organisational factors
Causative factors	Practical control measures
The nature of the task creates obstructions. Safety culture which is not supportive. For example where hazards and risks are accepted as part of the job.	Analyse the tasks and process flows to see if work can be handled to eliminate or minimise obstructions. Establish a positive attitude that trips can be prevented.

Individual factors
Causative factors	Practical control measures
Safe practices not followed.	Train, inform and supervise employees.

11.2 Appendix B Hazard identification checklist

Appendix B Hazard identification checklist

Document control

Version: 3.
Approved by: Corporate policy approval group.
Date approved: 19 May 2022.
Name of originator or author: Health and safety lead.
Name of responsible individual: Health, safety and security forum.
Date issued: 30 May 2022.
Review date: May 2025.
Target audience: All staff.

Page last reviewed: April 30, 2024
Next review due: April 30, 2025

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