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Transferring people safely (PDF 424kb)

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2. 30 WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY FURTHER INFORMATION WORKSAFE VICTORIA WorkSafe offers a complete range of OHS services including emergency response advice information and education inspections and audits licensing and certification publications and web based guidance WorkSafe publications can be downloaded from worksafe vic gov au RESOURCES Casual workers and labour hire Placing workers in safe workplaces WorkSafe Victoria 2006 Consultation Talking safety together WorkSafe Victoria 2005 Consultation A user s guide WorkSafe Victoria 2005 Information for employees WorkSafe Victoria 2005 General OHS Guide to the OHS Act 2004 WorkSafe Victoria 2005 Summary of the Occupational Health and Safety Act 2004 WorkSafe Victoria 2005 Manual handling Ballarat District Nursing and Healthcare Inc Safety Development Fund Project Final Report Musculo skeletal injury prevention program for district nurses Ballarat District Nursing and Healthcare Inc January 2003 A guide to designing workplaces for safer handling of people WorkSafe Victoria 3rd edition September 2007 No lifting policy Australian Nursing Federation Victorian Branch 2006 Victorian nurses back injury prevention project evaluation report Department of Human Services Victoria 2004 WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY 31 ACKNOWLEDGEMENTS This guide was developed by consultants Lo
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11. 4 yeq lqe snlpe 1u6reu pue Bulls ejqisjeuuuut Yum 2810 9139943 c v E K ssemeuw Ajeddis o MORO ped JO sseiew LL v 1SISSV OL Nav 6 pie s sn Jo s 2 JOO HO uosJed si9 sue Jueneg 5 OL o v AS SSV OL 318 3 leo le pie sasn Jo jes 3 weyo o eyo m siajsuey jueneg 6 II a c v 1SISSV OL av lt paq oluo pie s sn so 5 5 69 juoned x 8 v ISISSV OL 318V paq o Jieuo o ple sasn Jo jas OEE ONIN SJoJsueJ quoned V LSISSV OL 318 i eqo paq pie sesn 10 JJos dd suaysued queneg 9 V HSISSV OL 318V paq Jo epis uo HS xons peg E v p q ur uonisodeJ uJn Sjeeus pils v 1SISSV 3187 1104 lou d 1S1 4000 umop li dn iS pajejado Aj eou2e 3 e V 15155 OL 318V paq su umop dn AOV Jeg peeuJeAQ L 4003 H3 SNVUL 3170 u31SNVHL nu ned s nsu y bibu sp u er edg nu ned jo euieN sjlejap 19431N 10 6z 81 sabed o 13191 318 V1 AYWININNS LNAILWd WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY TOOL 3 PATIENT AND RESIDENT RECORDS This section contains forms for staff to use to identify risks and record the handling moving procedure The forms include provision for noting the patient s ability to assist the number of people required the type of equipment neede
12. are presented in a colour coded table Preferred methods are in green increased risk methods in amber which should only be used if it is not reasonably practicable to change to a green method and high risk or dangerous and not recommended methods in red 3 Patient and resident records Examples of patient recording forms that staff may use to identify risks and record the handling moving procedures 4 Task assessments and class risk assessments A description of each of the tasks from the Patient transfer guide and a discussion of the risk factors WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY 1 ABOUT THIS GUIDE 1 Identify any task that may be a risk to the health and safety of your staff 2 Determine the risk associated with that task including the likelihood and consequence of an injury occurring 3 Control the risk by eliminating it or if this is not practicable by reducing it as far as possible Consultation with health and safety representatives HSRs and employees should be undertaken at all stages of the risk management process HOW SHOULD THIS GUIDE BE USED This guide is flexible around your workplace needs It is the duty of individual employers to develop their own approach to preventing injuries associated with handling and moving people The tools in this guide are intended to be part of such a program They should be used in whichever way best suits each workplace and employer situation You are
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14. encouraged to customise and tailor the tools to integrate them into your own occupational health and safety management systems WHAT DUTIES DO EMPLOYERS AND EMPLOYEES HAVE Employers have certain obligations under the Occupational Health and Safety Act 2004 OHS Act and Occupational Health and Safety Regulations 2007 OHS Regulations Employers are responsible for their regular staff contractors and agency personnel This responsibility extends to providing a safe working environment appropriate job design and work systems and access to proper equipment support and training The Manual Handling section Part 3 1 of the OHS Regulations requires employers to identify all people handling tasks and eliminate any risks of musculoskeletal problems or if this is not reasonably practicable minimise the risk The OHS Act requires employers to consult with employees and their health and safety represenatives HSRs if reasonably practicable when identifying or assessing hazards or risks and when making decisions regarding risk control Under the OHS Act employees are also required to cooperate with the actions of their employers in relation to hazard identification risk assessment and risk control WHO SHOULD USE THIS GUIDE This publication has been produced specifically for employers managers OHS personnel staff trainers and HSRs in health and aged care settings The types of facilities include those that care for patients resident
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16. their legal obligations under the Occupational Health and Safety Act 2004 and its associated Regulations and Compliance Codes The following references support and complement this document OCCUPATIONAL HEALTH AND SAFETY ACT 2004 The OHS Act sets out general duties of care for employers employees designers manufacturers suppliers and installers The OHS Act enables Regulations and Compliance Codes to be made about the health safety and welfare of people at work OCCUPATIONAL HEALTH AND SAFETY The Regulations set out specific duties for REGULATIONS 2007 AND COMPLIANCE CODES employers and employees under the Act Compliance Codes give practical guidance on how to comply with the legislation A GUIDE TO DESIGNING WORKPLACES FOR This document assists health aged care SAFER HANDLING OF PEOPLE rehabilition and disability facilities to reduce risks to those who handle clients INDUSTRY POLICIES ON NO LIFTING FOR The policies state the manual lifting of EXAMPLE AUSTRALIAN NURSING FEDERATION people should be eliminated except in life VIC BRANCH NO LIFTING POLICY 2006 threatening or emergency situations Patients are encouraged to assist in their own transfers and mechanical handling aids must be used whenever they can help to reduce risk DEPARTMENT OF HUMAN SERVICES IMPLEMENTATION FRAMEWORK FOR THE INTRODUCTION MAINTANENCE EXTENSION OF NURSE BACK INJURY PREVENTION PROGRAMS NURSING VIC GOV AU
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18. OL 1 THE PATIENT RISK ASSESSMENT WORKSHEET The Patient risk assessment worksheet is set out on the next page It is a blank proforma that has been designed to help you e assess the overall risk of manual handling tasks conduct your own manual handling risk assessment using the completed tools as a guideline e assess the risk of manually handling moving a person who has special needs Risk assessment should include 1 Physical environment e furniture space equipment 2 Work practices e training e adequate staff numbers e work hours 3 Patient s ability to assist cognitive signs e physical signs e behavioural signs e clinical constraints ASSESSING THE PHYSICAL ENVIRONMENT In the physical environment managers and HSRs should inspect and assess each room of the facility This process will determine whether or not the buildings and equipment are compatible with the handling techniques to be adopted Required changes should then be made For example overhead track systems for moving patients residents significantly reduce the force exerted by staff compared with the force required to manoeuvre a mobile hoist Overhead hoists are more efficient and acceptable to clients and reduce the time needed to transfer a person They should be installed in all new and refurbished health and aged care facilities where transferring people is undertaken They are particularly suited to carpeted rooms in which it is difficult to manoe
19. ORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY TOOL 3 PATIENT RECORDS STEP 3 RECORD THE METHOD TO BE USED The information determined by the first two steps is then recorded on the person s risk assessment control form the modified care plan or in the Patient transfer guide Recording should be done when the patient arrives in the unit and whenever their condition changes significantly It may be done as often as every few hours for acute patients or typically monthly for long term patients or residents Three examples of how the information may be recorded are in this section see Tools 3 1 3 2 and 3 3 Completed examples are shown for each recording method You can choose one of these forms or adapt them to suit your own patient records HOW TO USE THE FORMS The forms may be used as follows e at the start of each new period eg every shift in acute care or monthly in long term care to assess the ability to assist of each person in their care refer to the Patient transfer guide and task descriptions to identify which method of transfer to use what equipment and support from other staff members will be required This is based on the cognitive and physical ability of the person that requires handling record that information on the patient s care plan or other appropriate form WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY co EXAMPLE TOOL 3 1 PATIENT RECORD VERSION ONE ACTIVITIES INITIAL PLAN ADMI
20. SSION OR REVISED PLAN DATE 1 10 2006 PATIENT I D LABEL DATE 2 10 2006 DATE 3 10 2006 On bed assessment D A z 35 a z Equipment SS x 2 OB 5 Off bed assessment D A A ag SL BS a Equipment ST LL LL E Mobility assessment D A A E z Equipment WC WH WH Hygiene D A 4 13 SC SC SC Speech sight hearing Hearing aid Hearing aid Hearing aid Observations specific BP 4 24 BP 4 24 BP BD Diet fluids weight Full diet Full diet Full diet Urine bowels NAD test daily NAD test daily NAD test daily Wound care Refer to dressing chart Dressing 4 24 Dressng BD Daily dressing Discharge plan In progress refer to progress notes In progress refer to progress notes In progress refer to progress notes ND L Jones L Jones L Jones 5 s AM J Smith J Smith J Smith c a PM T Brown T Brown T Brown PATIENT CRITERIA CODE Dependent D e Unable to understand and or cooperate Physically unable to carry out task Able to assist Understand cooperate Physically able needs assistance Independent MOBILISE Wheelchair Walking frame Wheely frame Gutter frame Walking stick 4 point or single Walking sling EQUIPMENT Sling hoist Standing hoist Slide sheets Overhead bar Bedstick Leg lifter Turning frame Bed mechanics Shower chair Shower trolley Slide board Wal
21. Y A P Y P PM P P MF P P V Y dF dF dV A Transferring people safely Handling patients residents and clients in health aged care rehabilitation and disability services Edition No 3 July 2009 A y 3 CONTENTS What is manual handling 3 Tool 1 The patient risk assessment worksheet 4 Tool 2 The patient transfer guide 6 Tool 3 Patient and resident records 8 Tool 4 Task descriptions and class risk assessments 16 Further information 30 The information presented in Transferring people safely is intended for general use only It should not be viewed as a definitive guide to the law and should be read in conjunction with the Occupational Health and Safety Act 2004 0HS Act and the Occupational Health and Safety Regulations 2007 OHS Regulations While every effort has been made to ensure the accuracy and completeness of the guide the advice contained may not apply in every circumstance Accordingly the Victorian WorkCover Authority cannot be held responsible and extends no warranties to the suitability of the information for any particular purpose and actions taken by third parties as a result of information contained in Transferring people safely Copyright 2009 ABOUT THIS GUIDE Injuries in health aged care rehabilitation and disability services due t
22. able to carry out task Able to assist Understand cooperate Physically able needs assistance Independent MOBILISE Wheelchair Walking frame Wheely frame Gutter frame EQUIPMENT Sling hoist Standing hoist Slide sheets Overhead bar Walking stick 4 point or single Bedstick Walking sling Leg lifter Turning frame Bed mechanics Shower chair Shower trolley Slide board Walking sling WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY TOOL 4 TASK DESCRIPTIONS AND CLASS RISK ASSESSMENTS In this section each of the tasks assessed on the Patient transfer guide is described briefly followed by a discussion of any risk factors identified in the task and an overall risk rating The aim is to provide help for you to judge whether the class risk assessments are appropriate to the situations you face The descriptions also act as a starting point for individual moving handling tasks for which the class assessments are not appropriate The descriptions and their assessments are set out on pages 18 to 29 Conditions applying to the class risk assessments The risk of each patient handling task was carried out assuming the following conditions If these conditions are different in your workplace and the difference increases the risk of injury or the task is carried out differently to that described an individual risk assessment for that task should be carried out Patient assistance Where it is stated that the pa
23. be able to carry out the task e staff are trained in handling procedures and using lifting and transferring equipment e staff trial all equipment in situ before purchasing behaviour physical ability clinical constraints cognitive function WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY 17 uonisod euidns e oiur paramo Udy s Apoq 1eddn sau ned eu Syoeq siejpueu eu WO sue sjuened ay Buinowas poq Jaddn sjuened eui uoddns ueui paq y dn Apoq s juened ay Ae pue 1 sjejpueu y0q suDiui s Juened ay Japun peuonisod spuey pue sue Jeddn s3uened y Jepun peuonisod Apog s v Sulsn eoue eq JO paq eui uo spuey Jano 1194 eoejd pue sulu Jeddn sjuened eui Japun spuey Jeuul 1194 JUI SIS puey uyog oeq s jejpueu ay ssoJoe peuonisod we Siuened y yum We Jeddn sjuened ay Jepun Jepjnous 1euui 1194 uonisod SJo pUeu y10q Apog Jeddn s juaied y Bunuoddns ejuAA uonisod Bunis e ojul si Apoq 1eddn S juened ej peuonisod si pag UIMO OJ eui sepnjoul eonoe4d snojeDuep stu SJep nous siejpueu eui Bursn paq eui dn si Juened ysisse 01 e qe JON 61 ISV Bulpeo ue eun Bulyoeal DUDHOAA MO 39104 Bunuexa soinjsod pJewe ww 5 jepinous 39119V4d 40N31N1N0944 LON AYNFNI ASNWI OL AIMN AYIA MASIY BI uened eui Buljo poq s Juened eu Japun W014 ino sie s eui Sulpi
24. d S40328j XSL ULEN opo pours ASI WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY 180 puosas y 01 JIeyo ay UJoJj 14 ay JOMO pue 1 sjejpueu u1oq Aisnoaueynuls s l siuened eui sdseJ6 s lpupu 19470 ay 1590 S juened ay ssoJoe spueu Buidsej6 Apoq 1eddn sau ned y 1epun pulyeq UJOJJ swe 51 suonsod pue Apoq Jeddn s juaned eui sy Anubis 1ejpueu UQ JIByo 18114 eui o 1xeu peuonisod SI JIEYD puooes ay DULAO OL ay s pnioul soloed snoJeDuep siu e Buisn eyo o paq UJ04J pay Ajjenueud s juaned ay ysisse 01 e qe 10N Duiuoeai 3ueujeAouJ 156 Bulpeo ua eun 90104 uBiu Bunuexe se1njisod PIEMAMY D Mi pex 8 doy JIeuo puooes ay olul juened v pue Aue y uay sie puey 4209 Jap noys uue Sjuened y s pun sue Jesu 1194 eoe d pue pu q u ned y epis Jayya uo puejs sia puey u1og ev 1511 y o sejDue 1uBu ye peuonisod 51 Jieuo puo s sy SUIMO OJ eui eonoeJd snoJeDuep siu hl We xoou Buisn JIeUo o paq WO1 pay Allenueuu Si juaned ay ysisse 01 e qe 10N Buiyoea Buipeo u A un 9910J uiu Bunjexe seinjsod piemyjmy 4 uue YooH 39119V4ud4 GAGNAWINOIIY LON AdfifNI ASNWI OL AIAN AYIA ASIA HOI eya puooes ay ey ay LUO juened ay siamo pue S L sjoAId syi pue Apoq siue
25. d and any special circumstances In some situations this can all be completed by using the Patient transfer guide and there will be no need to refer to this section Three versions of the Record form are provided as examples any of the forms can be used or adapted STEP 1 ASSESS ABILITY TO ASSIST OR LEVELS OF DEPENDENCE The staff member should identify whether the patient is able to assist or is dependent according to particular objective criteria For these purposes a patient would be identified as able to assist if they are able to understand instructions are cooperative and would be physically able to assist the process If they do not meet these criteria they would be determined as dependent Any special needs of the person that may affect the move should also be identified For example they may be resistant prefer to move to a particular side or may be deaf DETERMINE THE PATIENT S ABILITY TO ASSIST THROUGH cognitive signs e physical signs e behavioural signs clinical constraints STEP 2 SELECT THE SAFEST MOVING HANDLING METHOD Once the initial assessment has been carried out the staff member can then refer to the Patient transfer guide page 7 or Task descriptions page 16 to identify the lowest risk method appropriate to the situation These sections also identify the number of employees and type of equipment required to carry out the task safely USE THE LOWEST RISK METHOD W
26. equinN 2 gt uonduos q lt co juaned ES EL Lu OL de z S40398 ASIA UIEN oc m al pou li 3514 WORKSAFE VICTORIA TRANS BY o1uo 1uened eui 1amo s1e pueu y ui pue pe ouuai si paq y 1S IuM 1uened eui pjoy pue 11 siejpueu eu s l pue sdiu sjepjnous 1e 1uered euidns ujeeujepun swe suonisod Jejpueu uoe3 SUIMO O eui sepnjoui eonoejd snoJaBuep stu 3J0U JO Jano pabueyo ase Ae o pue paq eui eju 11 dooos e Buisn pjeu pue pay Aj enueuu 51 juened eu ysisse 01 e qe 10N Suluop l Buipeo u A un 90104 uBiu Bunjexe se1njsod plemmy ul 19030 10 re pue doy JIILIWYd 30N41N1N0344 LON AYNFNI ASNVI OL E AYIA ASIU HJIH Anubis juened eui Burjou Aq pe ouuei si 5 9u o1 paq wo juened y Bulaysues Yapjnoys pue diy 18 1995 eui s nd pue llon eui suee epis eui uo 1e pueu j ym Yapjnoys pue diy ye 1uened seusnd epispeq eui uo 1e puer pue paq ay usamjeq e se pieoqepi s eui uiM pue uo sexelq UUM paq eui o 1ueoefpe llon v uonisod u ned ay Buipjo1 Aq 1999 pue 1uened eui s pun 5 ay uonisog loul 10 1995 eoueunuooul JO MeJp 1905 WO 0q eui pue 5 1ed e Buisn ej o v o1uo paq eui UJ04J quened eui JejsueJ sJe pueu eu ysisse 01
27. ful movements or with loads not equal for both sides of the body 3 Reaching Reaching away from the body or over shoulder height for long periods or while exerting force 4 Continual handling of patients Daily work includes long periods of various patient handling tasks for 30 minutes at a time or two hours total per shift RISK FACTORS SOURCES OF RISK 1 Patient behavioural or cognitive variables Patients who are resistive unpredictable and uncooperative 2 Patient physical variables or constraints Patients with physical constraints eg large fragile rigid contractures fatigue 3 Clinical constraints or contraindications Clinical variables eg pain unable to lie flat IV lines drainage bags intubation frames 4 Poor environment design Limited space and access to working areas equipment not easily moveable narrow doorways clutter carpets ramps or changes of level at lifts slippery floors poor lighting 5 Inappropriate furniture and fittings Wind up or manual adjust beds low baths low client chairs no grab rails in bathrooms toilets or corridors 6 Inadequate or insufficient patient handling aids Inadequate numbers not readily accessible poorly designed not maintained in good working order 7 Staffing factors MEASURES TO ELIMINATE OR REDUCE RISK Inadequate staff numbers for safe handling staff inexperienced inadequatel
28. gh risk practices to be used is likely to be in breach of Occupational Health and Safety legislation THE GUIDE CAN BE USED TO quickly identify current work practices assess the risk associated with each practice choose the safest way of performing each task determine and record the method to be used with each patient at different occasions and times using the blank spaces provided Every situation is different For example the methods of transfer and handling are likely to change frequently within an acute care setting However they may remain comparatively constant over long periods in extended care If the conditions described in this guide are different in your workplace and the difference increases risk of injury or if the task is carried out differently to the method described you should conduct a new separate risk assessment WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY YI 11e pue doy Hil 19410 JO jie pue doy Yl je pue d r e pue dol Mil ie pue d y YI ie pue doy euo Ajj enue A yip We yooH YI pinous 10 HI ejper YI We JOOH Ue xooH Hil We YOoH 311 We YOoH S191209 OM AIlEnUEVN 1sejyoeq Ajjenuey seis Bunyi anig sjeeys paq pue p eoq pils 3 18497914S Ul Ayjenuew ri Jejsuen 1oAid Buipueis 4 enue 3 paq ojuo s 4411 Ajenuey Jejsuen JOAId Sulpuezs enue
29. ict Health Matthew Casey Caulfield General Medical Centre and the Royal Melbourne Hospital for the trial of tools in the workplace feedback to the authors and support with photographs 32 WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY WorkSafe Victoria Advisory Service 222 Exhibition Street Melbourne 3000 BONG tea s 03 9641 1444 MOE e 1800 136 089 Ena iil info worksafe vic gov au Head Office 229 Exhibition Street Melbourne 3000 on HR 03 9641 1555 llo lucc RE 1800 136 089 Website worksafe vic gov au Local Offices Balara me 03 5338 4444 Bend go 03 5443 8866 Dandenong e e 03 8792 9000 03 5226 1200 Melbourne 628 Bourke Street 03 9941 0558 Mi 03 5021 4001 MUA 03 9565 9444 Preston M 03 9485 4555 03 5831 8260 Traralgon 03 5174 8900 03 5721 8588 VVarrnambool 03 5564 3200 WSV542 04 03 10 9 9 09 9 09 9 9 9 9 9 9 9 9
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33. king sling WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY TOOL 3 1 PATIENT RECORD VERSION ONE ACTIVITIES INITIAL PLAN ADMISSION OR REVISED PLAN DATE DATE PATIENT I D LABEL DATE On bed assessment Equipment Off bed assessment PATIENT HANDLING ASSESSMENT Equipment Mobility assessment MOBILITY Equipment Hygiene Speech sight hearing Observations specific Diet fluids weight Urine bovvels VVound care Discharge plan ND AM SIGNATURE PM PATIENT CRITERIA CODE Dependent D Unable to understand and or cooperate Physically unable to carry out task Able to assist Understand cooperate Physically able needs assistance Independent MOBILISE Wheelchair Walking frame Wheely frame Gutter frame Walking stick 4 point or single Walking sling EQUIPMENT Sling hoist Standing hoist Slide sheets Overhead bar Bedstick Leg lifter Turning frame Bed mechanics Shower chair Shower trolley Slide board Walking sling WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY EXAMPLE TOOL 3 2 PATIENT RECORD VERSION TWO PATIENT I D LABEL PROCEDURE CODE EQUIP CODE EQUIP CODE EQUIP CODE EQUIP CODE EQUIP CODE EQUIP Sitting up A D A ying dovvn Bedrope Bedrope Moving u
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35. nd usnd llon o paq woy 1uened eui 1eJsueJ Ssemjeui 1 AOU ay e1eju 3uened eui juened ay ujeeujepun sseeui 1 AOU eu uonisod pue 3uened eui Joy paq eui epis 1eujie peuonisod sje pueH 10 2 ss meul Aladdijs 10 sseu1euJ eui Bursn lloz 01 paq wou 1uened eui jejsuea sjejpueu eu ysisse 01 a qe JON Seinisod pJewop WW v pie s sn Jo M s sJojsueJ juaned GOHLAIW q4444434d E EIERE RIE S1e pueu saquuinyy uondu s q quaned S40328 ASIA UIEN pours ys u VVORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY 28 51 lnp old y uleq eui jo 1no 1uened eui Jaysues o Uleq eui ol l JIeyo eui WO4 3uened eui 1ewo pue Aueo saejpueu u1og Ajsnoeuejjnuurs s1uened eui sdsejb je pueu 1eu1o eu s v s1uened eui ssojJoe spueu BuidseJj6 Apoq Jaddn s 1uaned ay pulyeq sue Jeu siu suonisod pue piemuo Apoq Jaddn s uaned eui seusnd Ja puey euo v S pnioul eonoeJd snoJeBuep 51 3J10U JO 1 18 pue do e Buisn y1eq eui jo no pue our juened y 41 Ajjenuew sjejpueu ay ysisse 01 ejqe 10N s1y6Biay Bunom mo Burpeo ue eun 39 04 uBiu seinjsod 5 111 49430 10 YI 1153 pue doy JIILIVYd
36. ned y Buibuliq oeq Sueo uay Je pueu ay Jepinous Je s jo pueu ay uo peuonisod s uiuo sau ned eu l q JIEM e YUM 1uened eu spjoy Jajpuey eui JO SIEM S1uoned y puey Je y pue xooing Jesu siuened ay Japun peuonisod SI puey Jesu s Je puey ay seeuy sau ned y JO epis Jayya uo peuonisod aie seau S Jo pueu ay poq SJe pueu eu punoje Jo dej 101 ui pessoJo sue sjjuened eu juened ay Jo 100JJ ul SI Jo pueu y eyo 18114 9y o sejBue 1uBu je SI 118U puooes ay SuIMO OJ eui sepnjour eonoeud snojeBuep stu n q JIEM 1100144 JO YUM Jajsues JOAId Buipueis e Buisn 19 10 JO eyd Jeuioue oj JIeyo e U104J par Ajjenueuu s juaned ay ysisse 01 e qe 10N DuiuoeoJ Bulpeo u A un 90104 uBiu Bunuexe se1njsod PIEMAMY JejsueJ zond Buipuejs HI enue 131101 40 dIVH2 OL dIVH2 WOH 1N3lIVd 9NIAOM 6 d33SNVUL JIeuo eui ojuo saajesuuayl J8 0 0 juaned y S SIsse s19n1 sUul u u 1e pueu eu YO puooes y jo 1u0JJ ui peuonisod ase Ady 181 os J8jsue pue pie Buipueis eui Sulsn dn pueis o 1uened y Sisisse sjonujsul Jeipueu eu JIeu9 OY 0 saBue 1uBu peuonisod SI eyo puooes ay pie Buipue s e sesn juened ay 19 10 10 Jreuo Jayjoue o JIeyo e WOJ o juaned eui S SISSe Jojpuey ay 1S SSE 01 e qv peo u A un seinjsod pJewop wy pre Buipueis CELERON ASIY dISVIYINI pJEMJOJ uee pue
37. ned eui pulyeq Bulls y uonisod pue ued 0 1uened eu lsisse 1onujsu paq o 120 WO iuened eui 19jsuen sJe pueu eui 1siou 91110919 liqouu peyunouu Duijieo eui Buisn ysisse 0 ejqe JON SeJnjsod prem me 4ufieu Burom MO Bulyoeoy ysioy Burs 91419913 panowaJ eq 01 Bui s 10 ueo 0 juened se pue JIeuo ay yo 1uened y Jaysuen SOIUBYOOLU 1S10U y Sulsn 1SIOY ay o Buys eui yoene pue sue sau ned eui s pun pue 398q ay jo ews s 3uened y 890 Duis eui uonisoq DJEMJOJ uea o juened eui 1sisse eDe1noou3 paq eui o eyo LOI JOJsueJ1 o juened y sisisse Jo pueu ay 1siou Buipueis eui Bursr ysisse 0 9 qy seinjsod puemyme 4uBieu SUD OAA mo Bulyoeay pie puejs 115 hisiou Bulls e ouu8J pue yoejeq Auesseoeu Ji pie ue Buisn paq ay o1uo 5 1101 YI o 3uened eui jonuisu ejqissod se oeq Je se paq eui uo UMOP Ys pue paq eui ay o sBa jo ui as uonisod pue paq eui o 0 juaned ay 1onasu seuoino Jay Jem jeaym se yons ajeudoldde se spie Suls l qouu pue Bui s Bunem ysnipe ai ejqeis SI juaned ay eouo Hoddns pue ul8u ns Jo swe pue 5 v Buisn uonisod Duipueis e ou dn ysnd 0 juan ed ay 3onasu ev ey JO 189 uue eui uo spuey pue uey eu Jo eui 01 sxoonng uonisod o 1uened eu 19nis
38. o the handling of people remain a major occupational health and safety OHS issue in Victoria despite more than 30 years of research in Australia and overseas For workers this can mean personal pain and discomfort which sometimes lasts for years affecting not only their work but their everyday lives families and relationships For employers this type of workplace injury may lead to WorkSafe claims and increased premiums and other costs and may affect morale INJURY STATISTICS IN THE VICTORIAN HEALTH INDUSTRY Hospitals and nursing homes All industries Victoria percentage percentage MSD 71 55 Back injuries 31 21 Manual handling related 59 44 Source WorkSafe Victoria claims data 2005 06 to 2007 08 inclusive This guide has been produced specifically for Victorian employers to assist in reducing the incidence and severity of injuries to their staff resulting from manual handling risks when transferring people This guide complements the publication A guide to designing workplaces for safer handling of people In the guide the terms people or patients have been used to include patients residents and clients The guide offers the following practical tools 1 The patient risk assessment worksheet A worksheet that guides the assessment of manual handling risks for an individual task 2 The patient transfer guide A set of completed risk assessments for 12 common transfer or moving procedures The assessments
39. onisog 194919118 UM 1SIoU 91119918 ue Bursn 1001 y UJ0JJ 1uened eui J9 SUe1 sjejpueu eu ysisse O a qe 10N SseJnisod puemyMe yay Bunuom mo Buiuoeeu 9 awe 194939135 YUM 38100 91119913 40014 440 1N311Vd SNIAOW 01 d33SNVUL Buys y AOW I pue JBAO OJ O1 juaned eui 1sisse jonujsu sIOy OY PAOLUAJ pue 1510 ay wo 1 5 eui uoejeq paq ay o1uo JAMO pue 1001 eui Ho dn 1uened eui Jaysuel soJueyoau SIOY y Bursf 1610 eui 0 Bulls v y9eny juened eui Jano ysIOY 9y J3MO pue uonisod S PIS 100 o1uo 1uened eui Aq 1uen ed ay Japun Bulls ay uonisog ysioy Bulls 91119919 ue Buisn 100 J ay W014 1uened ay JejsueJi sJe pueu eu ysisse 01 a qe 10N SseJnjsod piem me uBreu Bunuom mo Bulyoeay 3si0y Buijs 91439913 EIU EU 4344344144 31SIG q49n034 IYO ay UO 115 O punoJe Bulms Jo dn puejs pue 1895 neu ayy uo umop usnd o juened y si9na sul pue juaned eui jo 1u0JJ l eyo ay seoejd ueui Je pueu eu MOQ pue puey Jesu s v Yny uonisod Uday pue uonisod Bunnys e o ul dn ysnd o pe1onuisui ueu si 3uened eu epis 1194 uo 0 0 3uened eu j9n13su1 pue 1uened OY o 1xeu JIBy9 e e2e d EM e se yons pie ue Buisn 10011 BY H0 SeAjesuieui J9 SUe 1 0 3uened eui sjonajsut Jejpueu eu ysisse 01 e qv M pie s sn 10 H S Siaysued juaned 91npa 50Jd S1e pueu jo J
40. onoejd snojeBuep siu 1 wue xoou Buisn paq o 10014 Y u10J p li Ayjenuew si 3uened ay ysisse 01 ejqv 1uBieu Buom mo BuiuoeeJ Dulpeol u A un 90104 yBbly sounjsod puem my Y wae 4ooH awed 19497914S eui pue Sje S y JO SLAULI eu SAOWAI pue Jano o 0 1uened ay 15 sse 19n11su A llon p q o1uo JAMO pue Aveo pue oo ay Ho dn 1 pue euueJj Jeuo1eus JO SeAUEO Y YI Sjejpuer paq eu pue 1uened y o sol peuonisod s a 101 JO paq ay uened eui yjesulepun peuesul s ejs ay pue 1uened y peuonisod si 19497914S eui JO Sepis u1oq ojuo 1uened Aq 1uened eui s pun peuonisod s seAueo ay Buiwol oj eux sepnjout eonoeud snojeDuep stu 9J0UJ 10 G 5 e JO sejod pue seAued y Buisn 100 eu WO1 POI jenuew s 3uened au ysisse 01 e qe 10N 1uBieu Bunuom mo Hulyoee Dulpeol u A un 9210J ulu seinisod plemamy 1949 9 135 yy Aj enueui eujeJj epnueuusip pue sje s ay 1810 y UJ0JJ y9e19p pue paq y 01u0 BWW y Jamo7 0011 eui Ho Quened pue euJeJj eui H 0 so ueyaau 1SIOU v esf euJeJ eui 0 uoene pue y 1SIOy 9y JAMO pue uonisod y 0 y9eye pue 1uened y Jepun Sie s eui uonisog juened y punoJe owed eui u
41. p A D A n bed MB SSx2 OB m ul Turning D ca z in bed A SS x 2 A Rolling in bed A D A Sitting on A D A side of bed BM BM A Bed to chair D E P Patient transfers sel SL SL SL D Stabilise chair A D D D Din a Chair to bed SL SL SL d trans ers sel ea Stabilise chair 2 D A Chair to chair ST SL ST Patient transfers sel Stabilise chair Bed to trolley SS SS SS SS SS to bed Pat Pat Pat Pat Pat cz m D D D A WC Air chair Air chair WH WH Date 1 10 06 4 10 06 8 10 06 10 10 06 11 10 06 Signature L Jones T Brown L Jones T Brown L Jones Special needs Needs a lot of prompting to assist on bed 1 10 Roll gently onto left side discomfort 4 10 Mobilises short distance only 10 10 PATIENT CRITERIA CODE MOBILISE EQUIPMENT Dependent D Wheelchair Sling hoist Unable to understand and or cooperate Walking frame Standing hoist Wheely frame Slide sheets Gutter frame Overhead bar Able to assist Walking stick 4 point or single Bedstick Physically unable to carry out task Understand cooperate Walking sling 1 Physically able needs assistance Bed mechanics Independent Shower chair Shower trolley Slide board Walking sling 12 WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY TOOL 3 2 PATIENT RECORD VERSION TWO PATIENT I D LABEL PROCEDURE CODE EQUIP CODE EQUIP CODE EQUIP CODE EQUIP CODE EQUIP CODE EQUIP Sit
42. s onto the footplate feed self wash ovvn upper body Encourage to roll self lift ovvn legs onto the footplate feed self wash own upper body Date 1 11 06 1 11 06 1 10 06 Signature C Firth J Lee J Lee Special needs ay be resistive in the morning Gets up after 10 30am responds to conversation about flowers and gardening PATIENT CRITERIA Dependent Unable to understand and or cooperate Physically unable to carry out task Able to assist Understand cooperate CODE MOBILISE D Wheelchair Walking frame Wheely frame Gutter frame Walking stick 4 point or single Walking sling Physically able needs assistance Independent EQUIPMENT Sling hoist Standing hoist Slide sheets Overhead bar Bedstick Leg lifter Turning frame Bed mechanics Shower chair Shower trolley Slide board Walking sling WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY TOOL 3 3 RESIDENT RECORD PATIENT I D LABEL TASK MORNING AFTERNOON NIGHT On bed assessment a Move up the bed cea z Sit up lie down Reposition Off bed assessment a Bed to chair ca Chair to bed e Chair to chair Toileting Hygiene Mobility therapy Date Signature Special needs PATIENT CRITERIA CODE Dependent D Unable to understand and or cooperate Physically un
43. s and clients in acute aged care rehabilitation and disability sectors WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY ABOUT THIS GUIDE WHAT ARE THE LEGAL ISSUES Several different laws and policies outline the issues around manual handling and consultation This guide is designed to assist employers to comply with their legal obligations under the OHS Act and Regulations and Compliance Codes For further information refer to the Legislative and policy framework table on page 30 WHAT IS MANUAL HANDLING The term manual handling applies to any activity that requires the use of force exerted by a person to lift lower push pull carry or otherwise move hold or restrain any object or person Hazardous manual handling means manual handling that has any of the following characteristics repetitive or sustained application of force repetitive or sustained awkward posture repetitive or sustained movement application of high force exposure to sustained vibration or manual handling of live persons or animals e manual handling of loads which are unstable unbalanced or difficult to grasp and hold Occupational Health and Safety Manual Handling Regulations 2007 regulation 1 1 5 t Source WorkSafe Victoria claims statistics 2005 06 2006 07 and 2007 08 including public and private hospitals nursing and convalesence homes WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY 3 ik TO
44. sse 01 e qe JON iueuJeAouJ sey Buipeo ue eun 90104 uBiu se1njsod D YI ea o9 doy eyo y O u juened eui Jamo pue Aueo H uay sjejpueu u1og Jep nous uue Sjuened eui s pun suJJe Jesu 1194 goed pue pJeMJoJ pueg u ned eui 40 opis Jaye uo pueis SJe pueu y10g 0011 ay UO 199 1194 UUM peg eui jo epis y uo p uonisod S used BUIMO O eui sepnjour aonoeld snoJeDuep siu 41 We oou e Buisn eyo 0 paq uuoJj par Si juened eu ysisse 01 e qe 10N Buiyoea u A un 90104 uBiu Bunjexe sejnjsod pJewe yi we xooH ES 3 LON AYN NI ASNWI OL NEP REED ASIA H IH YO y OU paq y UJOJJ qu9ned eui S AAO pue sales SJOA SHI pue Apog s1uened ay BuiBuuq joeg suee ueui Jejpueu eu paq y episeq ejBue 1uBu e ye SI eyo eu Jepinous s Ja puey y uo p uonlsod eq Aew uiuo siuered y L 11 Q AEM e YIM 1uened eui spjou Ja puey y 10 siem 5 4 y punoije puey Jesu eui pue Jey s1uened ay Japun peuonisod SI puey Je s 1a puey eui sesuy suened eui JO epis Jayla uo peuonisod ae S UN s JJe pueu eui Apoq s a puey ay Jo de JIU Ul pessoJo sue sjuaied eu 1uened eui jo UOJ ui 51 Jejpueu ay 1001 y uo 1991 JOU YUM paq y epis eui uo si juened BuiwoJ eui sepnjoul oonoeJd snoJeB
45. tient is able to assist this means that e the patient can comprehend what the handler is saying and is reasonably cooperative e the patient is able to physically carry out the task Equipment e the equipment used is readily available in good condition and regularly maintained e all hoists and beds are electrically operated overhead tracking hoists are used wherever reasonably practicable e hoists are able to be wheeled under the bed with no impediment e the bed has electrically operated height and backrest adjustment and bed tilt mechanisms where required e slide sheets are at least two metres in length and are of a slippery material such as spinnaker sailcloth or similar e the slide sheet used in the bed to trolley transfer is at least two metres in length and 1 5 metres wide e a minimum of two handlers are used to manoeuver the hoist with the patient in situ Environment e the floor is a flat firm smooth surface eg non cushioned slip resistant vinyl or similar e the work area is reasonably uncluttered no furniture needs to be moved in order to carry out the tasks 16 WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY TOOL 4 TASK DESCRIPTIONS AND CLASS RISK ASSESSMENTS Employees e staff carrying out the task are trained and competent in no lifting patient handling procedures and in using the mechanical equipment and other aids in the handling task e there is an adequate number of staff available to
46. ting up lying down Moving up in bed Turning in bed ON BED Rolling in bed Sitting on side of bed Bed to chair Chair to bed OFF BED Chair to chair Bed to trolley to bed nz Mobili obility e SIGNATURE Special needs PATIENT CRITERIA CODE MOBILISE EQUIPMENT Dependent D Wheelchair Sling hoist Unable to understand and or cooperate Walking frame Standing hoist Wheely frame Slide sheets Gutter frame Overhead bar Able to assist Walking stick 4 point or single Bedstick Physically unable to carry out task Understand cooperate Walking sling 1 Physically able needs assistance Bed mechanics Independent Shower chair Shower trolley Slide board Walking sling WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY 13 EXAMPLE TOOL 3 3 RESIDENT RECORD PATIENT I D LABEL TASK MORNING AFTERNOON NIGHT On bed assessment D D D Move up the bed SS x 2 SS x2 ON BED Sit up lie down Electric backrest Electric backrest Electric backrest Reposition SSx2 Off bed assessment D D 6 Bed to chair SL SL ca Chair to bed SL SL Chair to chair ST ST D D Toileting As per regime As per regime ST to adjust clothes ST to adjust clothes Overnight pad Hygiene WC WC Mobility therapy Encourage to roll self lift ovvn leg
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49. uBieu SUL OAA mo uluos H 1siou Bulis 31139913 pJEMJ0J ue9 0 juened eui Aq Bulls ay pue 3stou ay WO1 Bulls y uoejeq euo y Olu paq eui Ho dn 1uened eui 19jsued 501 6 18104 y Burs isiou eui 01 Buijs v y9ene pue 1510 ay UO 189 1101 ooe d o juened eui eBeinoou3 suue S juened ay Japun pue 39eq y jo ews s1uened eui SsoJoe Duis eui uonsod PJEMJO ued 0 juened eui 1sisse oDe1no2u3 JOO OY uo 199 HAA paq ay jo epis y uo 1uened eui uonisog neu o paq v W014 JojsueJ o juened ay sisisse 1o pueu eu 1siou Buipueis 91119919 eui Sulsn ysisse 0 ejqv sainjsod u l u mo Bulyoeay 9 16104 Buipuejs 914393 Bulls anowua pue uoejeq UMOP 115 pue sue JIeyo eux dsei6 ued yeas y jo y o sBe jo YOR ULM H S uonisod pue 41802 au 0 01 3uened y 1onasu uoddns pue yibual s 104 swe pue 5 J1ayl Buipueis e olul dn usnd o 1uened y 1onusu seuoinio Jay em jeaym se yons ejeudoudde se spie Bulsijiqouw 9pI OJd 1ISISSE 0 paq eui esiei 10 puejs o juened ay 1onijsu 18104 ay pue juaned eui o Bulls Bubjew eui y9eny ool eui uo 1994 1194 YUM p q y JO epis eui uo 1uened eui uonisog Burs SUD EAA yum ysloy J921 pejunouu
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52. uioq paq eui epis uo Jayjo YORE e1isoddo pueis sJejpuer BuiwoJoJ eui sepnjour eonoejd snoJeBuep siu epis sl u o3uo peo UY pue jeeus eoueunuoour JO MeJp eui Buisn paq eui jo ejppiuu eui our pax si 3ueprsegAuened eu 1 151558 01 ejqe 10N SjueuJeA ouu 1sej Buipeo ue eun Hulyoees 39104 uBiu uonisod us 39U43UNUOJUI 40 JIILIVYd GAGNAWINOIIY LON AYNCNIASNWS OL YE AYIA ASIU HIIH Jeu1o eui UO JNO s1eeus eui Builind u y pue Apoq s juened eui jo epis euo Japun sjeeus epi s v Buiusnd Aq s1eeus epi s ay anouay siu Buunp opis sy uo paurejurew si Apoq si1uened ay paq eui eui olul Apog s iuened ay seusnd Jajpuey 19ylo eui JIYM sjeeus epi s y jo 1e Ae do eui sind 1e pueu eu epis o1uo 1uened eui Buijjoy ueui pue 3uened eui s pun s1eeus p s eui Buiusnd Aq 1uened eui s pun s1eeus 5 OM JO 1995 pilS SY uonisog Ssjeous epis Buisn epis o1uo 1uened eui uonisod v ysisse 01 e qe JON Buiyoeoy SGOHLIIN 3444444d 4614 0391034 4 suajpuey JequinN uondu s q yu ned 21 S40328 ASIA UIEN epo pours SY WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY peg eui 8 y Sulpils ejua uonisod Bunis eui olul Apoq Jaddn sau ned y s
53. uise O Shea O Shea and Associates No Lift Systems and Mark Hennessy Hennessy Services Pty Ltd in conjunction with the Patient Resident Handling Working Party as part of WorkSafe s Health and Aged Care Industry Project in 2002 Acknowledgement is made to the contribution of e The Health and Aged Care Consultative Committee Jeanette Sdrinis Australian Nursing Federation John Brooks Aged Care Association of Victoria Michelle Holian and Sarah Creane Department of Human Services Elizabeth Langford Injured Nurses Support Group Kerry Shearer Private Hospitals Association of Victoria Fleur Limpus Victorian Association of Health and Extended Care Frank Mielke and Matthew Casey Victorian Health Care Association Andrea Argirides Margaret Best and Greg Haywood WorkSafe Victoria e The Risk Assessment Working Party Janet Casey Aged Care Association of Victoria Angela Quero Aged Care Standards Accreditation Agency Lynn Nicholas Australian Hospital Care Katy Marshall and Jeanette Sdrinis Australian Nursing Federation Sally Lutter and Sarah Creane Department of Human Services Rosemary Paterson Montefiore Homes for the Aged Judy Falla Peter James Centre Bill Fitzgerald Southern Health Care Network Jeanette Kamar Northern Hospital Care Network Andrea Argirides and Judith Farrell WorkSafe Victoria and e Carmel Browne Dandenong Hospital Danielle Taylor Karingal Manor Sue Bartelman Ballan Distr
54. us 1uened eui BurjoJ Aq 1uened eui Japun 1eeus epi s pue 5 ay uonisog 9J0UI 10 Sjoeus pue pjeoqepi s Buisn 11 Je ous y o1uo 1uened eui Jajsued 5 eu ysisse 01 ejqe JON Bulyoeay us epi s pue pseoq pils A llon 10 ous eunpeooud eui y1eq eui Wo 3uened eui JejsueJi o pe1ejduuoo si ujeg eui ueuM jddeas pue Bulls y e ouJe1J Jo u1eq eui Buunp 1uened eu 1epun Bulls y e ee Aew Je pueu eu S104 eui e AOWAl pue 1510 eui wo Buijs eui yoejeg Uleq eui o1ul 1uened eu 1ejsuea solueuoeui 1s10y eui Husn jsiou v o1 eui uoeny 1uened eui s pun Bulls ay uonisogd 4uBieu e1eudoudde o uleq asiey 10 Z Duis jq s ww ue ui 1slou 9109 9 ue Buisn yjeq ejqeisn pe 1uDieu e jo ino pue ojul 3uened eui Jajsued sia puey eu ysisse 01 e qe JON seJnisod puemyme Bulyoeay M u1eq lqe snipe ubl uq pue Buljs lq isa ulull YIIM 3SIOU 911399143 SGOHLIIN 3443444144 SEMEN EL 31NP39301d sua puey JequinN uondu os q 29 ELY juened S40328 ASIA UIEN epo pours ys u WORKSAFE VICTORIA TRANSFERRING PEOPLE SA FURTHER INFORMATION LEGISLATIVE AND POLICY FRAMEWORK This guide is designed to assist organisations to reduce the risks associated with the handling of patients and assist employers to comply with
55. uvre mobile hoists Some simple suggestions to help you reduce risk e bedstick a bedstick attached to the side of the bed allows patients residents to help themselves to sit up on the side of the bed overhead bar an overhead bar enables the patient resident to help lift and reposition themselves on the bed slide sheet slide sheets made from slippery sailcloth or similar material can help to move the patient on their bed e bed rope a simple rope attached to the middle of the foot of the bed allows the patient to raise themselves from a lying to a sitting position WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY TOOL 1 THE PATIENT RISK ASSESSMENT WORKSHEET The following form is designed to assist managers employees and HSRs to assess the factors that contribute to hazardous people handling tasks If these factors cause risks to employees they must be controlled so far as is reasonably practicable The form can be used to assess e a common task For example transferring nursing home residents from bed to commode chair or e aspecific task For example moving a bariatric patient from an emergency trolley to a bed RISKS WHAT TO LOOK FOR WHERE AND WHEN TICK 1 Awkward postures 2 Exerting high force Prolonged or repeated postures eg bending forward or sideways twisting working at or below knee level Workers find the effort difficult eg holding restraining pushing fast force
56. y trained unfamiliar with patients or handling equipment working long hours BY WHOM AND WHEN CONTROL MEASURES COMPLETED AND REVIEWED Management representative Health and safety representative WORKSAFE VICTORIA TRANSFERRING PEOPLE SAFELY TOOL 2 THE PATIENT TRANSFER GUIDE The Patient transfer guide is set out on the next page It has been designed to assist you categorise the risks associated with handling patients in your workplace environment The guide is set out in a table It includes completed risk assessments for 12 common handling situations known as class or generic risk assessments The 12 tasks are listed down one side of the guide and the various methods for those actions performed are listed across the top of the page The page flows left to right the safest recommended methods are on the left of the page moving through to methods of increased risk on the right Colour coding from green through amber and finally to red has been used to reinforce the graduation from low risk methods to high risk non recommended methods The table is a summary of information about transfer types 1 12 For full details on these refer to pages 18 29 The high risk red methods described on the guide for example top and tail lift cradle lift hook arm lift are not recommended practice They are included to make it clear they are dangerous An employer who allows hi
57. yi ueui puey 1euijo v YIM sBa sau ned eui spjoy pue Apog Jaddn si1uened ay Japun wue Jesu Jeu siu suonisod Ja puey apis 1194 OJUO 1uened ay 9 04 19 puey v sepnjoui eanoeJd snojeDuep stu zol paq y epis y uo Sumis 01 BulA wouy pay Ajjenueuu 51 3uened eu ysisse 01 e qe 10N 20104 uBiu Bunjexe seinjsod 03 BuiA wou 141 fenueyy JIILIVYd LON AMNFNIASNVI OL AMANT AYIA ETE HOI peg eui 10 epis eui uo uonisod 1uBudn ue ui Duns 51 1uened eui nun 3sanyoeq eui Bursie1 enunuo peg eui 199J S u9172d ay 5 pue 1490 Jed gg Aje1euurxoudde o 159 39eq eu esieu epis JI9Y OJUO OJ pue sBe 1134 pu q o 1uened ay 401 paq eui jo epis eui uo uonisod peouejeq e ul Buys o BulA Wo 1uened eui esteJ o 1se yoeq 91119919 eui esf ysisse 01 e qv Buiuoeeu 1seJyoeq 21329 3 039 3H 40 3015 3H1 NO 1N3lIVd 9NILLIS 44 d3HSNVu L peq eui epis ay uo Sumis ueui eq I 3uened ay paq eui yo Apog 1eddn 1194 syll pue voq e pueu 1194 uBnouui seusnd 1uened y JlyM paq eui o 199 s Juaned eui epis Ssenjeuu ay jo eui 1e 199J s Juaned eui uonisog spiemdn Apoq jeddn 101 ysnd 0 WAY ejqeue O A 1590 1194 1e moqe puey s v uonisod o 1uered ay nnsul epis 1194 OJUO 19 AO OJ pue 6 s dn pueq o 1uened y e8e

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