Title Page

  • Date of Issue

  • Company Name

  • Your Name

  • Phone no.

  • Vehicle details

  • Site Pass no.

  • DRA and ATW Number

  • Are you signing more than just yourself?
  • Your Name

  • Phone no.

  • Vehicle details

  • Site Pass no.

Authority To Work

  • Site induction / Orientation been completed

  • Safe systems of work approved

  • Competence checked

  • Tools, equipment and personal protective equipment (PPE) checked

  • Specific details of the work to be carried out

  • High Risk Permit required? If 'Yes', CBRE Engineer to advise which Permit is required and attach Media image of completed Permit

Dynamic Risk Assessment

  • Does the contractor possess the appropriate trade specific qualifications and authority to perform the work?

  • Has the contractor checked in with the manager or engineers and do they have job sheets for the task?

  • Has the contractor advised the customer representative and the individuals in the area where they will be working?

  • If the contractor is working alone, has the onsite manager or engineers arranged for regular communication with the contractor during their work?

  • Does the Contractor understand the up-to-date MoP/SoP/EoP/ Run Book/Risk Assessment for the tasks?

  • Has the Contractor got the relevant “Safety Data Sheet” (SDS) for the chemical/substances?

  • Have you carried out an inspection of the tools/equipment?

  • Where required, are Calibration, Test certificates and Formal examinations in date?

  • Are the tools and equipment serviceable and fit for purpose?

  • Are access routes safe and adequate?

  • Is the weather, temperature of the work area and ventilation safe at work?

  • Does the contractor have adequate space and lighting?

  • Is the contractor protected from contact with power sources, falls from heights, machinery, and vehicles in motion?

  • Has the contractor set up the necessary "hazard barriers and warning signs" in and around the work area?

  • Is the contractor aware of emergency measures, including what to do in case of fire, exit routes, safety zone?

  • Is the contractor aware of how and where to obtain first aid and eye wash station?

  • Does the contractor know how to report hazards/incidents?

  • If PPE is necessary, does the contractor have it and is it approved?

  • Does the contractor know how to monitor the condition and how to use and maintain PPE?

  • Detail the PPE that should be used here.

  • Describe the RISK CONTROL measures that the Contractor has in place to manage the risk.

  • Is the Contractor satisfied that it is safe to perform the work in the manner in which it will be performed in that location and environment AND all necessary checks and emergency<br>procedures are in place and satisfactory?

Hazards to consider

  • Electrical Energy

  • Bio Hazard

  • Manual handling

  • Work near water

  • Lone working

  • Use of/ Exposure to gas or gasses

  • Fragile surface/ roof

  • Working at Height/ Fall/ Drop

  • Excessive noise

  • Adverse weather

  • Vehicle movement

  • Excessive vibration

  • Asbestos potential

  • Slips and Trips

  • Poor ventilation

  • Moving machinery

  • Dust/ Fumes

  • Confined spaces

  • Waste/ Pollution

  • Fire / Heat / Cold

  • Violence

  • Pressure/ Vacuum

  • Poor lighting

  • Chemical contact/ spill

  • Vermin

  • Access and Egress

  • Radiation

  • PPE

Risk Controls - Measures to Consider

  • Lone working arrangements

  • Effective means of communication (tested)

  • Two persons working

  • Authority for access

  • Inspection up to date

  • Pre-use check

  • Current SOP/ MOP

  • Stop and check asbestos register

  • Guarding

  • Powered platform

  • Podium tower

  • Approved ladders/ steps

  • Safe access equipment

  • Edge protection/ kickplate

  • Approved tools/ equipment

  • Permit to work

  • Lifting aids

  • Remote cooling/ heating

  • Adequate ventilation

  • Task lighting

  • Earthing and LOTO

  • Housekeeping

  • Waste control

  • PPE

  • Harness/ Lanyard

  • Floatation device

  • Inoculation (specify)

  • Hygiene and Egress

  • Atmospheric measurements

  • Fire/ First aid controls

  • Specialist training

  • Specialist intervention

Acceptance

  • Contractors Signature

  • Additional Signatures
  • Contractor Name

  • CBRE Engineer approving works

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.