Information
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Customer Name
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Customer Address
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Select date
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Operative
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Type of work carried out
Check List
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2 Minute Risk Assessment
Add assessment
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Location of works
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Select date
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Description of works:
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Are there any susbect materials which could be Asbestos Containing Materials and have not been confirmed
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Does the asbestos Register/Management plan show any Asbestos containing materials that will be affected by the works you arte carrying out in the area
If you answerd YES to either of these questions you must contact the health and safety officer for advise before you carry out any work
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Identify Hazards associated with works undertaken
- Loft Access
- Hot Works
- Use of ladder
- Lifting and carrying
- Underfloor access
- Drilling
- use of step ladder
- Handling waste
- cellar access
- Cutting/Grinding
- Tower scaffold
- Unsafe structure
- Access/Egress
- Dust
- Roof Works
- Poor Hygine
- Confrontation
- Hazardous Substances
- Weather Conditions
- Public
- Hand Vibration
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List additional hazards and explain in more detail
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Controls required reducing risks from hazards identified above
- Ear protection
- Fire Extinguisher
- Ladder anti-slip
- Warning signs
- Eye protection
- Heat mat
- Ladder stand off
- Barrier Tape
- Safety footwear
- fire check/permits
- loft board
- rigid barrier
- Safety helemt
- RCD
- Harness & Lanyard
- Two person lifting
- Hi Vis Clothing
- Tidy work area
- Lights
- Sack barrow
- Confirm exposure likey to be below 2.5m/s2A(8) EAV (100 Points)
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Additional information and controls not listed
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Occupier informed of risks
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Any further advise required
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Details of who to telephoned and the action/advise agreed:
Use http://www.hse.gov.uk/vibration/hav/vibrationcalc.htm to confirm virations expose if unsure
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Print Name
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Signed
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Date
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Have you completed the 2 minute risk assessment
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Do you have method statements and risk assessement available on-site
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Electrical permit to work
Add Permit
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Job reference number
Electrical Permit to work
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Address
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I certify that the following electrical equipment has been made dead, electrically isolated, earthed if necessary and all other relevent measures have been taken to ensure that the work and/or test specified below can be performed in a safe manner
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WORKS/TESTS to be completed
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Location of isolation
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Location of locks
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Location of keys
Authorisation
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Add signature
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Time and date
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Is an electrical permit to work required
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Is the isolation standard available on-site
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Does the installation require a NICEIC certificate? If so which one?
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Is the NICEIC certificate complete
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Is the installation fitted in accordance with manufacturers instructions?
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Does bonding meet requirements of BS7671
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Location of water bond?
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Proof of water bond
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Location of gas/oil bond
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Proof of bonding
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Have you fitted a 3 Amp fuse in carrier
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Add media
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If applicable is the circuit protected by an RCD?
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Proof of RCD protection
Extra information
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Is there any follow up works for other trades?
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Discription
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Is there any damage or custromers concerns?
Customer Satisfaction
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Was the appointment time kept
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Did the operative present ID card
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Were you advised of potenial hazards in line with HSE during 2 minute risk assessment?
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Did the operative protect the property with dust sheets and were safety signs in use?
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Were all operations explained to you?
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Has the operative left all operating and manufacturers installation instructions?
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Has the property been left clean and tidy
Comments
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Add any issues or additional comments
Sign off
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Customer Name
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I confirm that the job is complete
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Operatives Signature
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Add any issuess or additional comments
