Employer Details

  • Employee Address
  • E-mail address

  • Main Contact and Contact Number

  • Number of employees (approx).

  • Nature of Business and type of work being undertaken

  • Person responsible for Health and Safety

  • Have you ever had any enforcement action?

  • Type of Enforcement Action

  • Details of Enforcement Action

  • Date of Appraisal

  • Evidence of Employers Liability Insurance

  • ELI Review Date

  • Public Liability Insurance Viewed

Risk Rating & Frequency

  • High Risk - 12 Monthly - Construction, Engineering, Foundation & Community Studies
    Medium Risk - 18 Monthly - Creative Industries & Computing, Health & Social Development, Sports
    Low Risk - 24 Monthly - Business, Computing

  • Risk Rating

  • Next appraisal due

  • Areas Appraised

  • Other area/s

Health and Safety Policy

  • If 5 or more employees, a written Health and Safety Policy should be available

  • Has the employer a written Health and Safety Policy

  • How is the policy communicated

  • Other

  • How often is the Health and Safety Policy Reviewed?

  • Frequency

Risk Assessments and Control Measures

  • If 5 or more employees, the risk assessments should be written.

  • Has the employer written Risk Assessments?

  • Have the following subjects been risk assessed.

  • Fire

  • Workplace

  • C.O.S.H.H. - Control of Substances Hazardous to Health

  • P.U.W.E.R. - Provision and Use of Work Equipment Regulations

  • Manual Handling

  • Asbestos

  • Working at Height

  • Young Persons incl. special needs, disability, medical condition.

  • Examples of good control measures for young people:

  • Have the young person (not reached their 18th birthday) and the supervisor been informed of the risk assessments?

  • Comments

Learner Duties

  • Please give a brief summary of what duties the learner will be undertaking as part of their employment or work placement.

Accidents, Incidents and First Aid

  • What first aid equipment do you have.

  • Other:

  • How many first aiders do you have?

  • Where is the first aid box kept

  • Does the employer understand their responsibility for accident / disease / dangerous occurrence. (RIDDOR form F2508) and inform Burnley College if the reportable incident is an apprentice / student.

  • HSE website: www.hse.gov.uk/riddor/index.htm

  • Who is responsible for reporting Accidents / diseases / dangerous occurrences to HSE, EHO & Burnley College?

  • Where is the accident book kept?

Information, Training, Instruction and Communication.

  • How is Health and Safety Communicated?

  • Other:

  • Does the company have their own training plan, programmes, schedules

  • Does the employer provide an induction and on-going information, instruction and training for the young person

  • Examples:

  • Comments

Supervision

  • Name of Supervisor / Trainer

  • Experience and Qualifications

  • Any health and safety qualifications?

  • Comments

  • Are there any more supervisors / trainers?

  • Name of Supervisor / Trainer

  • Experience and Qualifications

  • Any health and safety qualifications?

  • Comments

  • Are there any more supervisors / trainers?

  • Name of Supervisor / Trainer

  • Experience and Qualifications

  • Any health and safety qualifications?

  • Comments

Personal Protective Equipment

  • Ear Protection

  • Areas of mandatory use

  • Protective Footwear

  • Areas of mandatory use

  • Overalls

  • Areas of mandatory use

  • Head Protection

  • Areas of mandatory use

  • Gloves

  • Areas of mandatory use

  • Respiratory / Dust Masks

  • Areas of mandatory use

  • Other

  • Areas of mandatory use

  • Eye Protection

  • Areas of mandatory use

Work Equipment and Machinery

  • Is your work equipment fit for purpose and up to the required safety standard?

  • Comments

  • Is the equipment properly maintained?

  • Comments

  • Are all guards suitable and in good condition?

  • Comments

  • Do you have manufactures information for your equipment readily available?

  • Comments

  • When was the last portable appliance testing carried out?

  • Is this date acceptable?

  • Comments

  • Are there any areas / activities the learner will be prohibited from entering or doing?

  • Comments

  • Does the company have any unguarded / exposed moving parts on machinery / equipment that may cause entanglement, abrasion, shearing, cutting, puncturing, ejection etc.

  • The learner must be prohibited from operating this equipment until adequately guarded.

  • Comments

  • Is the fixed wiring of electrical appliances inspected regularly (machinery, lighting etc.)

  • Comments

  • Is the gas supply regularly inspected?

  • Comments

Prohibitions

  • Working at Height

  • Working at Ladders

  • Roof work and work on fragile surfaces

  • Driving any vehicle / plant / machinery

  • Use of Lifting Equipment e.g. cranes

  • Demolition / Dismantling

  • Excavations or work in trenches or underground

  • Working on or near asbestos containing materials

  • Use of vibrating equipment e.g. angle grinders, power chisels/hammers, road breaking drills

  • Working on live electricity or gas

  • Working in confined spaces

  • Comments

Fire and Emergencies.

  • Does the employer have:

  • Fire Exits (clear and well signed) unobstructed and unlocked

  • Means of fire fighting, extinguishers etc.

  • Date extinguishers serviced (must be within the last 12 months)

  • Is the service date acceptable

  • Add service extinguishers to the action plan.

  • Means of raising the alarm?

  • Raising the alarm

  • Comments

  • Emergency Evacuation Drills

  • Fire Alarm Tests

  • Emergency Evacuation Procedures

  • Proper storage facilities for flammable liquids / gasses

  • Comments

Working Environment

  • Is the working environment suitable?

  • Housekeeping adequate?

  • Building structure adequate?

  • Heating and ventilation adequate?

  • Traffic routes suitable?

  • Do you carry out inspection tours to check on continuing compliance?

  • Frequency:

  • Comments

Hazardous Substances

  • Will the learner be exposed to any substances that are hazardous to health i.e. chemicals, fumes, adhesives, dusts, lacquers, asbestos, lead, radiation etc.

  • Name of hazardous substance

  • Hazard

  • Control Measure/s

  • Is the learner exposed to any further hazardous substances?

  • Name of hazardous substance

  • Hazard

  • Control Measure/s

  • Is the learner exposed to any further hazardous substances?

  • Name of hazardous substance

  • Hazard

  • Control Measure/s

  • Is the learner exposed to any further hazardous substances?

  • Name of hazardous substance

  • Hazard

  • Control Measure/s

  • Is the learner exposed to any further hazardous substances?

  • Name of hazardous substance

  • Hazard

  • Control Measure/s

  • Is the learner exposed to any further hazardous substances?l

  • Name of hazardous substance

  • Hazard

  • Control Measure/s

  • Biological hazards e.g. micro-organisms, fungi, bacteria and parasites possibly from contact with animals

  • Comments

General Health and Safety Management

  • Where do you get your health and safety information and advice from?

  • For further health and safety information. Please see www.hse.gov.uk/pubns/indg449.htm

  • Are the necessary health and safety signs in position and clearly identified?

  • Does the employer display a copy of the Health and Safety Law Poster

  • Does the employer deliver lifting / handling training?

Signs

  • Prohibition Signs (Red circular with a bar across)

  • Examples

  • Warning Signs (Yellow triangle)

  • Examples

  • Safe Condition Signs (Green square / Rectangle)

  • Examples

  • Mandatory Signs (Blue Circular)

  • Examples

Amenity & Welfare

  • Toilets (clean)

  • Washbasins

  • Plumbed in (warm) / cold water supplies

  • Soap / cleansers

  • Clean drinking water

  • Eating / drinking areas (clean)

  • Towels / hand drier

  • Heating

Safeguarding

  • Does the employer have policies / procedures for safeguarding of young people / vulnerable adults? (This includes abuse, neglect and involvement in extremism).

  • Inform the apprentice / student that there is assistance at the college. Refer to the college policy. www.burnley.ac.uk

  • Who is responsible for safeguarding?

  • What are the arrangements for safe guarding issues?

Recommendations Arising from the Appraisal

  • Is there evidence of in date Employers Liability Insurance (ELI) ?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Add drawing

  • Closed out date

  • Is there evidence of in date Public Liability Insurance (PLI) ?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is the Health and Safety policy compiled / reviewed?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Are risk assessments compiled / Reviewed (e.g. Young Persons, Fire)?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Are fire exits clear?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Are fire exit signs displayed?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Are fire extinguishers provided / serviced?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Are emergency evacuations practiced and recorded?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is the fire alarm regularly tested and recorded?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Are emergency evacuation procedures displayed?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Are there suitable storage facilities for flammable gases / liquids?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is there evidence of an accident book?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is there evidence of a Health and Safety Law poster?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is there a suitable first aid kit?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is there a suitable amount of trained first aiders?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Does the company provide mechanical aids for manual handling?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is there a sufficient means of providing heating?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is the lighting suitable?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Are there defined gangways?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is there a regular cleaning of waste?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Are there defined spillage procedures?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is there a safe means of access to racking?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is there a suitable system to segregate pedestrians fro moving vehicles?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is fixed wiring of electrical systems inspected and tested?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Are portable appliance suitably tested (PAT testing)?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is the gas system serviced?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Is the guarding / braking of machines suitable?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Are there suitable safeguarding procedures / policies?

  • Action to be closed out by Whom,

  • Action to be closed out by when?

  • Closed out date

  • Others / Comments

Sign Off

  • Employer Signature

  • Job Title

  • Burnley College Signature

  • e-mail to the employer and m.leatherbarrow@burnley.ac.uk

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