Health and Safety

Executive

Getting to grips with hoisting people

HSE information sheet

Health Services Information Sheet No 3

A short guide
This information sheet explains the problems
associated with hoisting people and sets out guidance
to deal with them. It covers fixed, mobile and
overhead hoists. The advice is intended for health and
social care providers or other organisations who move
and handle people and will help them to comply with
their legal duties.

What are the issues?

The use of hoists has become an integral part of
delivering health and social care services. Although
the use of hoists can reduce musculoskeletal risks,
you should consider the other risks associated with
hoisting people. Each year a significant number of
incidents are reported in which people have been
injured while being moved using hoisting equipment.
Between April 2001 and December 2007 there were
163 hoisting accidents reported to the Health and
Safety Executive under the Reporting of Injuries,
Diseases and Dangerous Occurrences Regulations
(RIDDOR). An average of 120 incidents per year are
reported to the Medicines and Healthcare products
Regulatory Agency (MHRA).
The degree of injury varies, depending on the
vulnerability of the hoisted person, the nature
and consequences of the fall and what the falling
person makes contact with. Falls during hoisting
have resulted in severe injuries, from broken bones
through to fatalities.

What can go wrong?

People can fall during hoisting for a variety of reasons.
Problems include:
Selection of the wrong size sling resulting in

discomfort if the sling is too small and a risk of the

person slipping through the sling if it is too large.*
Selection of the wrong type of hoist or sling for
the individual, or for the specific task resulting in
inadequate support and increased risk of falling

from the sling. For example, access/toileting slings

give a great degree of access but very little support
and their use should therefore be restricted to
toileting purposes, where appropriate.*
Incompatibility of the hoist and sling resulting
in insecure attachment between the two. For
example, incorrectly attaching a loop on a sling
to a spreader bar designed for a clip attachment,
or attaching a clip on a sling to a spreader bar
designed to take a loop attachment. Follow the
manufacturers advice and refer any concerns
about sling/hoist design, supply, manufacturers
instructions or compatibility claims to the MHRA,
the regulator for medical devices
(www.mhra.gov.uk).
Failure of equipment due to poor maintenance,
lack of inspection, inappropriate laundering
processes or as a result of inadequate repair or
modification.
Leaving a vulnerable person unattended in a hoist,
or in a position where they might be at risk of falling
from the bed or chair.
Hoist overturning when manoeuvring over difficult
surfaces, transporting an individual over a long
distance on a hoist, or not following manufacturers
instructions for use or safe systems of work.
Not using the safety harness/attachment (if the
sling specified for the individual has one).

* Note:
Sling sizes and coding varies between manufacturers. There is a
risk of using an inappropriately sized sling if you make assumptions
without checking the suitability of a specific sling for the individual.
For example, two large slings from different manufacturers may be
different sizes the body of the sling may be a different length or
the number of loop attachments may differ, resulting in a different
lifting position. Additionally, sling designs can alter over time, so a
new sling from a manufacturer may differ in size or attachment strap
length from one previously purchased. Some slings come with a
range of different length loops for attachment to the hoist. These
can be used to increase the comfort of the individual or put them
in a more reclined or upright position. However, you should take
great care to choose the correct loops for the individual so that they
are not at risk of slipping from the sling, and to use the same loop
configuration on both sides to reduce the risk of the person falling
from the sling sideways.
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Instability when moving someone on a mobile

hoist resulting in them striking objects. This

is likely to cause injury, especially to those with
vulnerable skin, and will increase the risk of a fall
or overturn. In many cases, assessment will show
that two handlers are required: one to operate
the hoist; the other to help steady things and,
where needed, support the persons lower legs to
keep them in a safe position when moving from
one place to another. Importantly, they can also
provide direct reassurance to the person being
hoisted to maintain their co-operation and reduce
the likelihood of them contributing to unstable
movement.
Case example: Mrs W had been resident in a
nursing home for two years. She was unable to
weight bear or move independently. While being
hoisted from a bath by a new care assistant who
had not received training, and had not used that
particular type of hoist and sling before, Mrs W
slipped from the sling and fractured her shoulder.
She died as a result of a subsequent pneumonia
infection. The hoist and sling used required active
participation of the resident and was not suitable
for Mrs W, or for hoisting from a bath. Risk
assessments and procedures for manual handling
and bathing had, in general, not been brought to
the attention of care assistants and supervision was
inadequate. The company was prosecuted and fined
90 000.

What should I do?

The person
Consider whether a hoist is the most suitable handling
aid and, if so, devise a handling plan to match the
individuals ability and meet their needs and those of
the workers involved. It should specify the appropriate
hoists and slings for the individual and the type of
transfers required. It should also take into account the
views and preferences of the individual being hoisted.
If in any doubt, seek competent advice.
The handling plan should cover the range of
activities where a person may require assistance
with moving and handling, eg transfers bed to chair,
into bath etc. The plan should be easy to read and
clearly state the control measures for moving and
handling the individual, including:
specific equipment needed;
techniques to be used;
number of handlers required;
sling attachment loops to be used; and, where
applicable
leg configurations etc.

Examples of a patient moving and handling

assessment form and safer handling plan can be
found in the All Wales NHS Manual Handling Training
Passport and Information Scheme:
http://www.wales.nhs.uk/documents/NHS_manual_
handling_passpor.pdf
The equipment
Lifting equipment is subject to additional requirements,
including a thorough examination by a competent
person. Hoists and slings are medical devices and the
equipment manufacturer is required to provide suitable
instructions for use, including compatibility information
and guidance on the checks you should carry out
before each use.
The staff
Share the handling plan with all those involved to
ensure that workers know how to handle each
individual. They may also be able to contribute to
the development of the handling plan to ensure the
chosen options are workable. Make sure that staff
are trained in the specific equipment and techniques
so that they have the skills and competence to carry
out the handling plan and understand the risks and
measures to control them. The Management of
Health and Safety at Work Regulations 1999 require
employers to have access to competent persons who
can assist them in the measures needed to comply
with health and safety requirements. Employees have
duties too; they should:
follow appropriate systems of work, as identified

for individuals in their handling plan, and use the

equipment provided;
co-operate with their employer and let them know
of any problems; and
take care to ensure that their activities do not put
others at risk.
The lift
Before hoisting, undertake an assessment of the
risks, taking account of the individuals handling plan,
and put in place actions to reduce the risk of injury.
Lifting operations should be properly planned and
carried out in a safe manner in accordance with the
Lifting Operations and Lifting Equipment Regulations
1998 (LOLER). The Workplace, Health, Safety and
Welfare Regulations 1992 require those in control
of workplaces to make sure that floors and traffic
routes are maintained in good condition and free from
obstructions, and that there is suitable lighting and
ventilation in the workplace

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Maintenance
Ensure there are adequate systems in place for
maintenance and inspection of hoists and slings in line
with the manufacturers instructions, the Provision and
Use of Work Equipment Regulations 1998 (PUWER)
and LOLER. The MHRA device bulletin on managing
medical devices, DB2006(05), gives some guidance
on this topic.
LOLER: Where lifting equipment, including hoists
and slings, is used by people at work the Lifting
Operations and Lifting Equipment Regulations apply.
In addition to routine maintenance and servicing,
LOLER requires lifting equipment to be inspected
and thoroughly examined. Thorough examination
by a competent person is required either at sixmonthly intervals or in accordance with a written
scheme of examination drawn up by a competent
person. A competent person is someone with
the relevant technical knowledge and practical
experience of lifting equipment to enable them to
detect defects or weaknesses and to assess their
importance in relation to the safety and continued
use of the specific equipment being examined.
Monitoring
Check that handling plans are being followed, and
revise and update if the needs of the individual or
other factors affecting the plan change.
Training
Employers need to make sure that staff receive
adequate training and information on people moving
and handling. Practical training has an important
role to play in ensuring that staff have the skills and
confidence to hoist people safely. In addition to
practising equipment selection and use, staff need
to understand the principles of hoisting, the potential
risks, how to use the specific equipment they have
in their workplace and how to implement individual
handling plans.

It is important that supervisors also receive training

so that they are able to monitor, identify and correct
poor practice. There is no firm rule about how
often training should be given. However, skills will
inevitably deteriorate over time. Provide update or
refresher training periodically, or when competency
assessment identifies the need for further training.
You will also need to provide training when new lifting
aids are introduced, or there are changes to the
method of work.
Case example: An immobile, 90-year-old patient,
Mrs B, suffering from dementia, had been on a
rehabilitation unit for some time following a fall.
She was assessed by a nurse as needing a smallsized full-body sling for all transfers in hospital. No
other patients on the ward at that time required
the small sling and the sling was usually found in
her wardrobe. The sling had not been detailed on
her moving and handling risk assessment or care
plan, which simply stated hoist for all transfers plus
two people. When two staff, who had not been on
duty for some weeks, were getting the dependent
patients up and washed, they found the small sling
in Mrs Bs room. Mrs B protested that it wasnt
the right sling and that the sling had hurt her. So,
instead, they used the large full-body sling, which
was draped over the hoist, to lift her from the bed to
a commode. During hoisting, Mrs B slipped down
through the access aperture in the sling and rapidly
fell, striking her head. Mrs B died and the hospital
was subsequently prosecuted and fined 20 000
plus costs for failing to ensure her safety because
the correct sling size had not been communicated
to staff, nor did they know how to correctly size and
select a sling for this individual.
The annexes to this guidance provide safety checks
and other measures for employers and those hoisting
people to consider to help them ensure safe handling.
Figure 1 provides a checklist for using a mobile hoist in
the form of a useful flowchart.

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Annex 1 Checklist to help with hoisting

The following checklist, compiled by a group of
manual handling professionals, represents safe
handling practice and will remind those hoisting
people of points to consider to reduce the risk.
The list does not aim to cover every individual
circumstance and assumes that the handler has
received relevant and current training in the transfers
and equipment used.

Checklist

they are being lifted to obtain sufficient clearance.

Check attachments remain secure and the person

is comfortable before proceeding further.

If there are any problems, lower the person into a

safe position and seek further advice.

Follow manufacturers instructions and local

policies and procedures with regard to care and

cleaning of the hoist.
Place battery-powered hoists on charge, as
identified in the instructions, when not in use or
ensure back-up battery is charged.
Do not leave the person unattended in a hoist.
Additional guidance for mobile hoists

All hoisting tasks

Avoid using the hoist to transport over distances,
Read the handling plan and ensure it is current

and relevant.
Review the persons condition prior to each
transfer to ensure continued suitability for hoisting
and the use of the equipment.
Ensure the persons weight does not exceed the
SWL of both the hoist and sling.
Do not use the hoist/sling unless you have had the
necessary training.
Check the correct hoist and sling specified in
the handling plan are available and servicing and
thorough examination are in date.
Ensure the equipment works and is free from
observable defects before starting.
Hoists and slings must not be adapted or misused.
Before each use, check the hoist and sling in
accordance with the equipment manufacturers
guidance on inspections and pre-use checks.
Familiarise yourself with the hoists emergency
lowering systems.
Check there is a sufficient number of handlers to
carry out the task safely in accordance with the
handling plan.
Ensure the environment is free from obstacles and
the floor free of slip and trip risks.
Ensure the support surface is ready and safe to
receive the person.
When manoeuvring the hoist into position to
connect to the sling, bring the spreader bar/carry
bar down slowly, holding where necessary, to avoid
contact injuries with the individual.
If there are any concerns about the equipment,
task, person, environment etc, handlers must
follow organisational procedures immediately.
Communicate with everyone involved in the task
at all times.
Ensure safety and comfort of the person at
all times.
Reassure the person at all times and involve them
as much as possible.
Prior to raising, check the sling is positioned
correctly and double check the sling attachments.
Hoist the person just above the surface from which

thresholds or different surfaces unless otherwise

stated in the handling plan.
Do not apply brakes during hoisting with
mobile hoists (unless otherwise stated by the
manufacturer and handling plan). Note: This does
not apply to certain types of equipment where the
brakes need to be applied, for example standaids.
Ensure hoist legs are in the most stable position.
Store the hoist in a safe place with boom/jib
in lowest position and with brakes on when
not in use.
Additional guidance for ceiling track/overhead
hoisting systems
The motor should be directly overhead, and make

sure the lifting tape is vertical to the lift to avoid

wear and tear and/or malfunction.
Elevate the spreader bar to its highest possible
position when not in use.
Return the hoist to its docking station, where
appropriate, for charging when not in use.
Ensure the tracking and pathway is clear of
obstructions.
Be familiar with how freely the motor moves on
the tracking.
If using a portable lifting pod/motor, develop,
implement and follow guidance for a safe way of
transporting and attaching.
Do not drag the pod/motor using the lifting tape as
it may cause damage to the hoist.

Additional guidance for standing hoists

The person must be able to consistently and

reliably bear weight through their legs and have

sufficient upper body muscle strength/sitting
balance.
The person must be able to co-operate and
physically participate in the hoisting process.
Some standing hoists need using with care if the
person has knee problems, sensitivity or vulnerable
skin on their legs.
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Additional guidance for slings

Ensure the sling is compatible with the hoist.
Double check the loops/clips are attached to the

spreader bar throughout the hoisting procedure.

Use the correct loop/clip configurations as

identified in the handling plan.

Ensure the sling and attachments are not caught/

stuck on any equipment when starting the lift.

Additional guidance for bath hoists
Make sure staff are fully trained on the specific bath

hoist and with the equipment in the bathrooms. For

example, height-adjustable baths etc.
Ensure the environment is safe. For example, floors
not slippery/wet, sufficient space.
Using bath oils, bubble bath, lotion, talc etc may
make the surfaces slippery and affect the use of
the equipment.
Check the temperature of the water.
Ensure correct fitting of lap strap (also known
as safety belt/seat belt/safety harness) unless
otherwise risk assessed.
Mobile and ceiling track hoists may also be used
for bathing see mobile and ceiling track hoist
guidance.

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Annex 2 Equipment safety checks prior

to each use
Is the equipment as specified in the handling plan?
Do the hoist and sling have a CE mark on them?
Is the persons weight below the SWL of both the

hoist and sling?

Are hoists and slings within LOLER thorough

examination dates?
Has the hoist been serviced in accordance with

manufacturers instructions?

Environment
Ensure:
the environment is prepared for the task;
there is sufficient space and access around and

under furniture to use the hoist safely;

the floor is clear of obstacles, eg trailing cables;

and
there is a suitable and safe area to store and

charge (if applicable) the hoist.

Has there been any change in the individuals

circumstances since the handling plan was

devised?
Has a visual check of the equipment been carried
out prior to using it?
Is the environment ready?
Is there sufficient space to use the hoist safely?

If you identify a fault with either the hoist or sling

withdraw from use immediately and follow the
organisations reporting procedures.
These guidelines have been developed in conjunction
with National Back Exchange (Yorkshire branch).

Hoists mobile (electric and hydraulic), ceiling

track systems, stand aid, bath
Ensure:
the hoist is fully charged, the battery and any leads

are fitted correctly;

there are no obvious signs of damage or fluid leaks

from the hoist;

the raise/lower mechanism works and the

emergency stop button is set correctly;

the lifting tape is intact and not frayed (applies to

ceiling track, certain mobile hoists);

the castors move freely, ie free from carpet fibres/

fluff etc (mobile and standing hoists); and

the base adjustment/hoist legs move freely (mobile

and standing hoists).

Slings
Ensure:
the sling is the correct size and type for the client

and is fit for purpose;

sling and hoist are compatible;
all labels are legible and show the SWL and unique

identifier and size;

there are no signs of fraying, tears or deterioration

etc;
all stitching is present and intact;
the velcro (if applicable) is clean and free of fibres/

fluff etc;
the buckle (if applicable) has no signs of damage

etc;
the loops/clips have no obvious signs of damage,

fraying etc; and

it has been cleaned.

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Had up-to-date moving and handling training, including hoist training?

Feel confident to use hoist?

START THE TASK

NO

DO NOT USE

t YES
Current and relevant person-specific handling plan for using hoist?

Check with supervisor

NO

t YES
Persons condition/ability same as when they were assessed for this equipment? n Do you have consent? NO

Number of handlers available as per handling plan?

t YES
NO

Familiar with this specific hoist & sling?

t YES
NO

ENVIRONMENT Area safe for hoisting, ie

BEFORE THE TASK

n sufficient space? n clear of obstacles? n access around/under furniture? n clean/dry?

t YES
NO

HOIST

Familiar with emergency stop and lowering systems?

t YES
NO

SLING

Sling compatible for use with this hoist?

t YES
NO

Sling is one identified in handling plan and is still appropriate

(ie right size and type, cross reference with care plan)?

t YES
n

NO

t YES
Visual check made of sling, ie
n clean and undamaged? n label legible SWL clearly displayed? n unique identifier?
n LOLER examination/service up to date (6 monthly)?

NO

n Unlock hoist brakes

(unless otherwise assessed)

Hoist brakes OFF (unless otherwise specified in manufacturers instructions)?

NO

Re-attach and re-check

t YES
Visual check made of hoist, ie
n battery charged? n LOLER examination/service up to date (6 monthly)?
n no obvious signs of damage? n hoist moves freely on castors backwards and forwards?
n base adjustment and lifting/lowering mechanisms move freely?
n emergency button set in correct position? n SWL clearly displayed and not exceeded?

Fit as per handling plan

NO

t YES
Sling loops/clips attached securely and correctly to hoist?

NO

t YES
n

Sling safety harness/belt secured if there is one?

NO

Person looks safe and comfortable?

Sling smooth under person? n Sling leg configuration correct?

t YES
NO

Re-fit sling

t YES
n

Persons legs safe distance from mast?

DURING TASK

n Turn spreader bar,

giving person more leg room

NO

t YES

Persons position correct?

Are they comfortable?

NO

Hoist again, then reposition

t YES
n

Detach sling from hoist

Remove sling (if applicable) ensuring person left in safe position

t YES
n

Hoist & sling suitable for next use, ie clean, undamaged?

t YES
n

Store hoist in suitable, safe place

AFTER TASK

n Hoist with hoist legs widened (unless handling plan states otherwise) until straps tight
n Recheck person is safe, comfortable and correctly positioned n Start full hoist

NO

Clean hoist and/or report damage

and/or launder sling
following organisational procedures

Recharge hoist (if applicable)

Figure 1 Checklist using a mobile hoist

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Further reading
The Guide to the Handling of People a systems
approach (Sixth edition) BackCare 2011
ISBN 978 0 9530 5281 3
Back in work Back pack 22 June 2010
www.nhsemployers.org/HealthyWorkplaces/MSDs/
Pages/Backinwork-backpack.aspx
Managing medical devices DB2006(05) Medicines and
Healthcare products Regulatory Agency 6 November
2006

Further information
For information about health and safety, or to report
inconsistencies or inaccuracies in this guidance, visit
www.hse.gov.uk/. You can view HSE guidance online
and order priced publications from the website. HSE
priced publications are also available from bookshops.
This guidance is issued by the Health and
Safety Executive. Following the guidance is not
compulsory, unless specifically stated, and you
are free to take other action. But if you do follow
the guidance you will normally be doing enough to
comply with the law. Health and safety inspectors
seek to secure compliance with the law and may
refer to this guidance.
This document is available at www.hse.gov.uk/pubns/
hsis3.pdf.
Crown copyright If you wish to reuse this
information visit www.hse.gov.uk/copyright.htmfor
details. First published 06/11. Amended 12/11.

Published by the Health and Safety Executive

HSIS3

09/12

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