Title Page
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Conducted on
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Prepared by
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Location
PART I: PRESTART. Use this form if you’re doing work involving LADDERS, LIVE ELECTRICITY, CONFINED SPACE, or work that poses a safety hazard for other people.
Site Address / Job #
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Date
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Time Start
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Time Finish
Required Risk Assessments and Documentation – complete to flag any required documentation
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MOBILE SCAFFOLDING, setting up
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Use a Mobile Scaffolding TA
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CONFINED SPACE roof space / Underfloor
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Use a Confined Space TA
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ELEVATED WORK PLATFORM
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Use a EWP TA
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SHORT DURATION ROOF WORK
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Trained user, setup harness in fall restraint
OTHER RISKS IN TODAYS TASKS Tick all that apply, add what you need to. If you’re unsure contact your supervisor.
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Risks and how they can harm us or a bystander.
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Control – ELIMINATE first, MINIMISE second
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Live circuits
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Live circuits
Staff, Contractor, Home-Owner or Involved Public Sign Induction I have been inducted to Site and Explained the hazards / Risks involved with the job. I will ask my supervisor if I have any questions
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Name
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Signed
POST JOB Complete after job has been finished.
Your feedback – how can we make this task better for next time?
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COC completed
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Lockouts completed
