Information
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Document No.
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Project number
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Street / Road / Site name
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Date
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Prepared by
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Add signature
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- N SMART
- K AINSWORTH
- A MANSELL
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Location
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Person controlling the risks on site
- N SMART
- K AINSWORTH
- A MANSELL
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Names of personnel on site affected by the works
- N SMART
- M DUCE
- K AINSWORTH
- A AINSWORTH
- R HITCHIN
- A MANSELL
- D SMART
Site works
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Are persons affected by the site works
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- Operitives
- Sub-Contractors
- Other persons / public
Work activities
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Description of works / are site works being carried out
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- New service
- New mains
- New mains & service
Site activities will involve the following
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Is there a job risk
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Job risk category
- HIGH
- MEDIUM
- LOW
Pre start checks
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Team leader to ensure the following
- Risk assessment carried out
- Correct site address
- All ness army plans on site
- F91 up to date
- BA checked
- Fire ex checked
- All fittings on site
- No scaffolding present
- All plant & tools on site
Team signatures
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All team members to comply with the instructions issued by the team leader and abide by company risk assessments, method statements. All team members to print & sign below
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Add signature
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Add signature
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Add signature
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Add signature
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Add signature
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Add signature
Site specific risk assessment
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Risk 1
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Potential hazard and associated risk
- Traffic
- Site plant
- Underground services
- Above ground services
- Excavations
- Inclement weather
- Gas escape
- Scaffolding
- Pneumatic pressure testing
- Purgeing
- Slips, trips, falls
- Grundomat mole
- Fire
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Who affected
- Operitives
- Sub-Contractors
- Other persons / public
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Initial risk
- HIGH
- MEDIUM
- LOW
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Control measure
- RA 1
- RA 2
- RA 3
- RA 4
- RA 5
- RA 6
- RA 7
- RA 8
- RA 9
- RA 10
- RA 11
- RA 12
- RA 13
- RA 14
- RA 15
- RA 16
- RA 17
- RA 18
- RA 19
- RA 20
- RA 21
- RA 22
- RA 23
- RA 24
- RA 25
- RA 26
- RA 27
- RA 28
- RA 29
- RA 30
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Revised risk
- HIGH
- MEDIUM
- LOW
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Person responsible for control measures / monitoring
- N SMART
- K AINSWORTH
- A MANSELL
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Risk 2
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Potential hazard and associated risk
- Traffic
- Site plant
- Underground services
- Above ground services
- Excavations
- Inclement weather
- Gas escape
- Scaffolding
- Pneumatic pressure testing
- Purgeing
- Slips, trips, falls
- Grundomat mole
- Fire
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Who affected
- Operitives
- Sub-Contractors
- Other persons / public
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Initial risk
- HIGH
- MEDIUM
- LOW
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Control measure
- RA 1
- RA 2
- RA 3
- RA 4
- RA 5
- RA 6
- RA 7
- RA 8
- RA 9
- RA 10
- RA 11
- RA 12
- RA 13
- RA 14
- RA 15
- RA 16
- RA 17
- RA 18
- RA 19
- RA 20
- RA 21
- RA 22
- RA 23
- RA 24
- RA 25
- RA 26
- RA 27
- RA 28
- RA 29
- RA 30
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Revised risk
- HIGH
- MEDIUM
- LOW
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Person responsible for control measures / monitoring
- N SMART
- K AINSWORTH
- A MANSELL
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Risk 3
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Potential hazard and associated risk
- Traffic
- Site plant
- Underground services
- Above ground services
- Excavations
- Inclement weather
- Gas escape
- Scaffolding
- Pneumatic pressure testing
- Purgeing
- Slips, trips, falls
- Grundomat mole
- Fire
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Who affected
- Operitives
- Sub-Contractors
- Other persons / public
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Initial risk
- HIGH
- MEDIUM
- LOW
-
Control measure
- RA 1
- RA 2
- RA 3
- RA 4
- RA 5
- RA 6
- RA 7
- RA 8
- RA 9
- RA 10
- RA 11
- RA 12
- RA 13
- RA 14
- RA 15
- RA 16
- RA 17
- RA 18
- RA 19
- RA 20
- RA 21
- RA 22
- RA 23
- RA 24
- RA 25
- RA 26
- RA 27
- RA 28
- RA 29
- RA 30
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Revised risk
- HIGH
- MEDIUM
- LOW
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Person responsible for control measures / monitoring
- N SMART
- K AINSWORTH
- A MANSELL
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Risk 4
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Potential hazard and associated risk
- Traffic
- Site plant
- Underground services
- Above ground services
- Excavations
- Inclement weather
- Gas escape
- Scaffolding
- Pneumatic pressure testing
- Purgeing
- Slips, trips, falls
- Grundomat mole
- Fire
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Who affected
- Operitives
- Sub-Contractors
- Other persons / public
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Initial risk
- HIGH
- MEDIUM
- LOW
-
Control measure
- RA 1
- RA 2
- RA 3
- RA 4
- RA 5
- RA 6
- RA 7
- RA 8
- RA 9
- RA 10
- RA 11
- RA 12
- RA 13
- RA 14
- RA 15
- RA 16
- RA 17
- RA 18
- RA 19
- RA 20
- RA 21
- RA 22
- RA 23
- RA 24
- RA 25
- RA 26
- RA 27
- RA 28
- RA 29
- RA 30
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Revised risk
- HIGH
- MEDIUM
- LOW
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Person responsible for control measures / monitoring
- N SMART
- K AINSWORTH
- A MANSELL
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Risk 5
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Potential hazard and associated risk
- Traffic
- Site plant
- Underground services
- Above ground services
- Excavations
- Inclement weather
- Gas escape
- Scaffolding
- Pneumatic pressure testing
- Purgeing
- Slips, trips, falls
- Grundomat mole
- Fire
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Who affected
- Operitives
- Sub-Contractors
- Other persons / public
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Initial risk
- HIGH
- MEDIUM
- LOW
-
Control measure
- RA 1
- RA 2
- RA 3
- RA 4
- RA 5
- RA 6
- RA 7
- RA 8
- RA 9
- RA 10
- RA 11
- RA 12
- RA 13
- RA 14
- RA 15
- RA 16
- RA 17
- RA 18
- RA 19
- RA 20
- RA 21
- RA 22
- RA 23
- RA 24
- RA 25
- RA 26
- RA 27
- RA 28
- RA 29
- RA 30
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Revised risk
- HIGH
- MEDIUM
- LOW
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Person responsible for control measures / monitoring
- N SMART
- K AINSWORTH
- A MANSELL
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Risk 6
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Potential hazard and associated risk
- Traffic
- Site plant
- Underground services
- Above ground services
- Excavations
- Inclement weather
- Gas escape
- Scaffolding
- Pneumatic pressure testing
- Purgeing
- Slips, trips, falls
- Grundomat mole
- Fire
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Who affected
- Operitives
- Sub-Contractors
- Other persons / public
-
Initial risk
- HIGH
- MEDIUM
- LOW
-
Control measure
- RA 1
- RA 2
- RA 3
- RA 4
- RA 5
- RA 6
- RA 7
- RA 8
- RA 9
- RA 10
- RA 11
- RA 12
- RA 13
- RA 14
- RA 15
- RA 16
- RA 17
- RA 18
- RA 19
- RA 20
- RA 21
- RA 22
- RA 23
- RA 24
- RA 25
- RA 26
- RA 27
- RA 28
- RA 29
- RA 30
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Revised risk
- HIGH
- MEDIUM
- LOW
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Person responsible for control measures / monitoring
- N SMART
- K AINSWORTH
- A MANSELL
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Risk 7
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Potential hazard and associated risk
- Traffic
- Site plant
- Underground services
- Above ground services
- Excavations
- Inclement weather
- Gas escape
- Scaffolding
- Pneumatic pressure testing
- Purgeing
- Slips, trips, falls
- Grundomat mole
- Fire
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Who affected
- Operitives
- Sub-Contractors
- Other persons / public
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Initial risk
- HIGH
- MEDIUM
- LOW
-
Control measure
- RA 1
- RA 2
- RA 3
- RA 4
- RA 5
- RA 6
- RA 7
- RA 8
- RA 9
- RA 10
- RA 11
- RA 12
- RA 13
- RA 14
- RA 15
- RA 16
- RA 17
- RA 18
- RA 19
- RA 20
- RA 21
- RA 22
- RA 23
- RA 24
- RA 25
- RA 26
- RA 27
- RA 28
- RA 29
- RA 30
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Revised risk
- HIGH
- MEDIUM
- LOW
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Person responsible for control measures / monitoring
- N SMART
- K AINSWORTH
- A MANSELL
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Risk 8
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Potential hazard and associated risk
- Traffic
- Site plant
- Underground services
- Above ground services
- Excavations
- Inclement weather
- Gas escape
- Scaffolding
- Pneumatic pressure testing
- Purgeing
- Slips, trips, falls
- Grundomat mole
- Fire
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Who affected
- Operitives
- Sub-Contractors
- Other persons / public
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Initial risk
- HIGH
- MEDIUM
- LOW
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Control measure
- RA 1
- RA 2
- RA 3
- RA 4
- RA 5
- RA 6
- RA 7
- RA 8
- RA 9
- RA 10
- RA 11
- RA 12
- RA 13
- RA 14
- RA 15
- RA 16
- RA 17
- RA 18
- RA 19
- RA 20
- RA 21
- RA 22
- RA 23
- RA 24
- RA 25
- RA 26
- RA 27
- RA 28
- RA 29
- RA 30
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Revised risk
- HIGH
- MEDIUM
- LOW
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Person responsible for control measures / monitoring
- N SMART
- K AINSWORTH
- A MANSELL
Additional information
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Add media
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Additional information added by
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- N SMART
- K AINSWORTH
- A MANSELL
