Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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S-Reference (eg S123456)
Description of Work
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Number of Workers
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Workers Names
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Generic Risk Assessment Numbers
- RA NO 34 OHSF–PR-03-04-34 - Civils
- RA NO 34 OHSF–PR-03-04 - FQS
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Please describe works being undertaken.
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Have you been granted permission from the property owner
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Who granted permission
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Signature
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Please give a description of works being undertaken and what you aim to achieve.
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What are the Hazards and the actions taken to reduce the Risk.
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Photos of work area and excavation area
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All required work equipment, PPE & tooling in good order and checked prior to use.
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Please confirm items being used and checked prior to use
- PPE
- Cat & Jenny Service avoidance kit
- GDU
- Site safety barriers
- Insulated shovels
- Stihl saw
- Dust suppression kit
- Battery operated Breaker / Demolition hammer
- Whacker Plate / Compactor
- Insulated Hand Tamper
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Have you obtained LSBUD prints if working near public boundaries and / or Shared drives.
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Area scanned for buried services (Chalk marked / highlighted) referencing safe dig prints and locating with Cat and Genny. ATTACH PHOTOS
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Safety Barriers and Site guarding set up. Attach Photos
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Have site staff been briefed on work operations & implications?
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ADDITIONAL HAZARDS AND CONTROL MEASURES NOT LISTED WITHIN GENERIC RISK ASSESSEMENTS WILL HAVE A BEARING UPON OPERATIONS AND MUST BE LISTED BELOW.
Add task
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Task Name
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Hazards Identified
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Additional Control Measures Required
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Remaining Risk
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All required work equipment, PPE & tooling in good order and checked prior to use.
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Please confirm items checked prior to use
- PPE
- Cat & Jenny Service avoidance kit
- GDU
- Site safety barriers
- Insulated shovels
- Stihl saw
- Dust suppression kit
- Battery operated Breaker / Demolition hammer
- Whacker Plate / Compactor
- Insulated Hand Tamper
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Search before you Dig prints available highlighting other services in work zone
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Area scanned for buried services (Chalk marked / highlighted) referencing safe dig prints and locating with Cat and Genny.
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Photos of Site Markings highlighting buried services identified from Cat & Jenny site scans
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Why have you not scanned and marked hidden services?
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Work area and safety signage erected & established? NRSWA
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Photos of site Barriers / Signage
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You should be using safety barriers for all activities. please correct and adjust site in accordance with safe work practices
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Works Start notified to Street Works team
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Permit / Notice number displayed and visible
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Photo of Notice boards and Notice number
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If Excavating in a public area you need a permit. Continue only if working on private land. If public please go back and correct the Risk assessment.
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Have site staff been briefed on work operations & implications?
Completion
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Please confirm that this risk assessment is accurate for the task being conducted and the operatives on site are trained and competent to carry out the task
Sign Off
CF Employee
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Authorisation : I confirm all safety measures and control systems in place
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Signature
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Date/Time
Additional Site Staff
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Site Staff: On behalf of the site, I have reviewed and agree to these work arrangements
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Signature
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Date/Time
