Client handling in health care
Learn how to prevent musculoskeletal disorders when health care workers perform client handling activities.
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Client handling is the lifting, transferring and repositioning of a client, patient or resident. This task is a common activity performed by health care workers and can lead to musculoskeletal disorders (MSDs) due to:
- gradual and cumulative wear and tear on the body due to repetitive client handling
- a one-time exertion due to high forces or awkward postures
MSDs are the most common cause of lost-time injuries among health care workers. Good ergonomic design of client handling activities can prevent these injuries.
The following outlines legal requirements under the Occupational Health and Safety Act regarding client handling activities.
Keep equipment in good condition
Under clause 25(1)(b), employers must make sure the equipment, materials and protective devices they provide are maintained in good condition.
If equipment is not in good condition it can be:
- more physically demanding for the worker to use
- more difficult to use
For example, if client handling equipment, including slings, is in disrepair, a worker might need to use extra physical force to operate it.
Provide information, instruction and supervision
Under clause 25(2)(a), employers must provide workers with information, instruction and supervision to protect their health and safety.
Examples of information and instruction about client handling include, how to:
- use proper client handling techniques
- use mechanical lifts and transfer aids
- recognize and report MSD hazards
- recognize the signs and symptoms of MSDs and the importance of early reporting
Under clause 25(2)(d), employers must make sure that workers or a person in authority over a worker (for example, a supervisor or manager) are acquainted with the hazards in their work. This includes MSD hazards when performing client handling activities.
Take every precaution reasonable in the circumstances
Under clause 25(2)(h), employers must take every precaution reasonable in the circumstances for the protection of a worker. This includes protecting workers from MSD hazards while performing client handling activities.
Regulations that apply
In workplaces where the O. Reg. 67/93 Health Care and Residential Facilities regulation applies, there are provisions that apply to client handling activities, including:
Actions for workplace parties
Measures and procedures
Section 8 of O. Reg. 67/93 Health Care and Residential Facilities requires that measures and procedures for the health and safety of workers are developed, established and put into effect by the employer in consultation with the joint health and safety committee (JHSC) or health and safety representative (HSR) and upon consideration of recommendations of the JHSC or HSR.
Subsection 9(1) of O. Reg. 67/93 Health Care and Residential Facilities requires that those measures and procedures are in writing.
If client handling activities occur in health care workplaces to which O. Reg. 67/93 Health Care and Residential Facilities applies, written measures and procedures for client handling are required.
Measures and procedures should include:
- safe work practices for:
- each individual lift, transfer or reposition
- assessing the client, environment and equipment in preparation for the lift, transfer or reposition
- client mobility assessments including documentation of a client’s mobility status and review and revision as status changes
- proper use, maintenance and operation of equipment
- pre-use inspection of mechanical devices and their accessories (for example, slings)
- use of mechanical devices (such as ceiling lifts, portable lifts and sit-to-stand lifts)
- safe storage and maintenance of client handling equipment and other mobility devices
- reporting of unsafe or defective devices, equipment or work surfaces
When measures and procedures are being developed, important factors to consider include:
- following the manufacturer’s recommendations for the use of the lift (for example, number of workers required to safely operate the client handling equipment, sling requirements, etc.)
- size and weight of the client when determining equipment needs and number of workers required
- medical history of the client (for example, involuntary motions, history of falls, etc.)
- cognitive ability of the client to comprehend the actions of the workers
- the availability of emergency back-up or additional equipment when equipment is in disrepair or being serviced
Subsection 9(2) of O. Reg. 67/93 Health Care and Residential Facilities requires that an employer review and revise measures and procedures in light of current knowledge and practices at least once a year.
Subsection 9(3) of O. Reg. 67/93 Health Care and Residential Facilities requires that the review and revision of the measures and procedures be done more frequently than once a year if the employer, on the advice of the joint health and safety committee or health and safety representative determines that such a review and revision is necessary, or there is a change in circumstances that may affect the health and safety of a worker.
Standards can assist workplaces in determining current knowledge and practice. Examples of standards on client handling include:
- Canadian Standards Association Z10535.1-15 Hoists for the transfer of disabled persons – Requirements and test methods
- Canadian Standards Association Z10535.2-17 Lifts for the transfer of persons – Installation, use, and maintenance
Education and training
In addition to the requirements of OHSA clause 25(2)(a) for information and instruction as outlined above, subsection 9(4) of O. Reg. 67/93 Health Care and Residential Facilities requires training and educational programs for workers in the health and safety measures and procedures that is related to their work.
The training and education programs are required to be developed, established and provided by the employer in consultation with and in consideration of the recommendations of the JHSC or HSR.
When training and educational programs for staff on the measures and procedures for client handling are being developed, it is a good practice to consider the following components:
- a training session for workers on the written measures and procedures
- a practical hands-on training component in which workers can practice the measures and procedures and receive feedback on whether they are being completed correctly
Training on the measure and procedures related to client handling is required for all workers who performs lifts, transfers and repositions, as well as for supervisors who need to ensure that workers are following the measures and procedures and performing the work safely.
Machinery and equipment
In addition to the requirements of OHSA clause 25(1)(b) for maintenance of equipment as outlined above, Section 44 of O. Reg. 67/93 Health Care and Residential Facilities has requirements for machinery and equipment that would apply to client handling equipment and accessories, such as slings.
Client handling equipment and accessories must be:
- suitable for its actual use (clause 44(a))
- for example, the employer needs to ensure that appropriate equipment is available for bariatric clients
- inspected immediately before its use and at regular intervals as recommended by the manufacturer (clause 44(e))
- serviced and maintained in accordance with the recommendations and instructions of the manufacturer (clause 44(f))
- operated by a worker trained in its use and function (clause 44(g))
Client handling equipment must be used where available. Supervisors must ensure workers use the equipment that the employer requires to be used (OHSA clause 27(1)(b)) and workers must use the equipment that the employer requires to be used (OHSA clause 28(1)(b)).
If you need more information about safety requirements, please contact the Ministry of Labour, Training and Skills Development Health & Safety Contact Centre at:
This resource does not replace the Occupational Health and Safety Act (OHSA) and its regulations and should not be used as or considered legal advice. Health and safety inspectors apply and enforce these laws based upon the facts they find in the workplace.
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