Title Page
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Select Title
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Conducted on
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Prepared by
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Location
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What is the length of time the worker may be alone
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What time of day are they required to work alone
Potential hazards
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Mobile phone contact is available at all times
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How will the alarm de raised in an emergency
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Designated contact times have been established with the office
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What is the time interval (in minutes)
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What other options have been put in place
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Will the emergency communication system work properly in all situations
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Is the work in a remote location that makes immediate rescue from emergency services difficult
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How will this be remedied
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What is likely to happen if there is a vehicle breakdown
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What machinery, tools and equipment may be used
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Are high risk activities involved
- Working at heights
- Working with electricity
- Working with or near mobile plant
- Demolition of a structure
- No high risk activities
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What controls are to be used
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Is fatigue likely to increase risk (eg: long driving hours)
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Is there an increased risk of violence or aggression when workers have to deal with clients or customers by themselves
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Can environmental factors affect the safety of the worker (exposure to hot or cold environments)
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Is there a risk of attack by animals - including reptiles, insects
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Does the worker have the required training for the works
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Can the worker able to make sound judgements about their own safety
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Are there any pre existing medical conditions that may increase risk
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Please list
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Reviewed by
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Does a manager need to be notified
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Have they been notified
