Information
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Document No.
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Site Address / Block Name
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Postcode
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Client
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Conducted on
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Prepared by
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Location
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Personnel Onsite
Risk Assessment
Working at Heights
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1.1. Fall risks of 2m or more? (including voids, pits, and trenches)
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Add notes and pictures
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Add Notes
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1.2. Lack of edge protection?
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1.3. Unsafe or incomplete edge protection?
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Are you able to complete height work safely
Cable Pulling And Work Area
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Are You Able To Complete Task Safely
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Have You Tested All Chambers For Gas
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Can All Chambers Be Guarded With 4 Sided Guards
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Have You Setup Chapter 8
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Base Of Ladders Guarded
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Work Area Guarded
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Photo Of Work Area
Plant and Equipment
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2.1. Unsafe or damaged plant/equipment? (including missing or damaged guards)
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2.2. Incorrect plant /equipment for job? (e.g. grinding discs for cutting)
Harness and Equipment
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5.1. Unsafe or damaged harness or equipment?
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5.2. Incompatible hooks/equipment?
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5.3. Unlabelled or does not meet AS?
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5.4. Unsafe or uncertified anchor points?
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5.5. Lack of inspection protocol for equipment?
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5.6. Lack of or inadequate formal training for operators?
Ladders
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6.1. Unsafe or damaged ladders?
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6.2. Unsafe positioning of ladders?
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6.3. Ladder not properly secured?
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6.4. Ladder unsuitable for job? (e.g. metal ladder used for electrical work)
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6.5 Is There Unsafe Ground
Hazardous Manual Tasks
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7.1. Lack of identification hazardous manual tasks?
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7.2. Lack of assessment of hazardous manual tasks?
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7.3. Inadequate risk controls? (examples: no job rotation, lighter loads, trolleys, lifting equipment, etc)
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7.4. Lack of training in risk controls and safe lifting/ team lifting techniques?
Hazardous Chemical (including fuel and oil)
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8.1. Unsafe storage location? (e.g. flammables near ignition sources, spills could enter stormwater drains, etc)
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8.2. Incompatible chemicals stored near each other?
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8.3. Inadequate spill containment equipment?
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8.4. Safety Data Sheets not accessible on site?
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8.5. Lack of emergency procedures for injury/spills/fire etc?
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8.6. Excessive quantities stored on site or in vehicles?
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8.7. Insufficient ventilation?
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8.8. Insufficient, or incorrect, PPE?
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8.9. Unsuitable storage containers? (unlabeled or stored in food containers)
Personal Protective Equipment (PPE)
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Do You Have All PPE Items
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Please add a note
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Hard Hat With Chin Strap
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Safety Harness Equipment
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Ear Defenders
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Goggles
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Gloves
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11.1. Lack of, or inadequate PPE (including sun protection)
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11.2. Lack of system to issue, inspect, replace and monitor PPE?
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11.3. Lack of training in safe use, clean-up and inspection of PPE?
Work Environment
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12.1. Lack of/or inadequate amenities? (toilets, wash areas, lunch rooms, etc)
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12.2. Insufficient lighting?
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12.3. Inadequate housekeeping?
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12.4. Lack of, or inadequate noise/ vibration control?
Environmental Hazards
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14.1. Lack of/or inadequate Environmental Management plan (EMP)?
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14.2. Lack of/or inadequate, dust suppression system?
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14.3. Lack of/or inadequate systems to prevent contaminants entering stormwater drains?
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14.4. Lack of water re-use systems?
Welfare Information
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Is There A Welfare Unit Onsite
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Local Toilet Facilities
http://www.mcdonalds.co.uk/ukhome/Restaurants/restaurant_locator.html -
Local A&E Hospital
http://www.nhs.uk/service-search
Additional Hazards
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List additional Hazards
Corrective Actions
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Enter any corrective actions that will be undertaken
Sign Off (to be signed by all crew onsite
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Persons onsite
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Persons onsite
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Persons onsite
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Persons onsite
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Persons onsite
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Persons on site