Title Page
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Conducted on
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Prepared by
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Location
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Specific Area
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Department
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Team Member(s) Involved
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Access / Egress / Barriers / Area Controls
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Access / Egress / Barriers / Area Controls
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Emergency Exits
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Emergency Exits
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Floors and Walkways
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Floors and Walkways
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Lighting for the work area
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Task Specific Lighting
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Emergency Equipment - Is it suitable and sufficient
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Emergency Equipment
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Is the individual aware of the hazards present at the job
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Hazard Awareness
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What control measures are in place to mitigate the hazards present?
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Hazard Mitigation
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Do you have the correct equipment to do the work safely?
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Correct Equipment
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Is all required electrical/mechanical equipment in a safe condition?
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Safe use of work equipment
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Is there appropriate separation of public and staff during the work?
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Separation of Public and Staff
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Are hazardous/dangerous substances used and stored according to their safety data sheets?
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COSHH
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Is your PPE Suitable and Sufficient for the task?
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Have any manual handling risks been identified and assessed?
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Have any Manual Handling risks been identified and mitigated?
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Housekeeping Arrangements
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Housekeeping
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Is there a Hot Works Permit in Force?
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Is there a Working at Height Permit in Force?
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General Comments
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Any Actions required?
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Sign off
