Title Page

  • Job Description

  • Conducted on

  • Prepared by

  • Location
  • Provide photographs of the working area before you start work.

  • I can confirm the job pack contains the method statement, safe working procedure and the associated risk assessment.

  • Contact your manager immediately to request missing documents

  • Is electrical testing required on completion?

  • Please fill out an electrical testing form

Part 1

  • Establishing General Safety & setting to work. These are the actions I have taken to establish General Safety.

  • Safe Tools & Equipment, Safe Access & Egress including that in an emergency, Safe Method of Work, Correct PPE - Safe Working Area (TM).

  • Lead Operative

  • Operative

  • Operative

  • Operative

  • Have you reported to the site agent?

  • Why?

  • Does the working party fully understand the method statement and risk Assessment associated with the works

  • The risk assessment and method statement can be found in your work pack. Do not start work, contact your manager for a copy

Part 2

  • The purpose of this section is to record any dynamic checks made by the working party to confirm that the job and immediate area are controlled to allow people to work safely. Please record any significant findings on this POWRA to improve future planning. If additional hazards arise and there are no, or inadequate controls identified within the work pack (risk assessment , method statement), Part A needs to be completed and additional control measures put in place before work commences or consult your manager. IF the controls already identified are adequate then no entries are required in Part A.

  • Controlling exposures to hazards in the workplace is vital. The hierarchy of controls is a way of determining which actions will best control exposures. The hierarchy of controls has five levels of actions to reduce or remove hazards. The preferred order of action based on general effectiveness is:
    • Elimination - Removes the hazard at the source
    • Substitution - Is using a safer alternative to the source of the hazard. When considering a substitute, it’s important to compare the potential new risks of the substitute to the original risks.
    • Engineering controls - Reduce or prevent hazards from coming into contact with workers. Engineering controls can include modifying equipment or the workspace, using protective barriers, ventilation, and more
    • Administrative controls - Establish work practices that reduce the duration, frequency, or intensity of exposure to hazards. This may include: work process training and job rotation.
    • Personal protective equipment (PPE) - Worn to minimize exposure to hazards. Examples of PPE include gloves, safety glasses, hearing protection, hard hats, and respirators.
    Using this hierarchy can lower worker exposures and reduce risk of illness or injury.


    Hierarchy of controls.jpg

Part A - Additional Potential Hazards other than already Identified within work the pack.

  • Slip / trip / fall

  • State your additional control measure. This could be erecting barriers around potential hazards, removing the hazard from the area, clearing up spillages to avoid slips.

  • Falling objects

  • State your additional control measure. This could be erecting safety netting , tethered tools , arranging a suitable time with other contractors / colleagues within the area to avoid potential hazards from other working parties. Appropriate PPE - hard hat, safety glasse.

  • Flying object ( ejected )

  • State your additional control measures. This could be ensuring any kinetic energy has been been dissipated before hand, the use of netting / barriers to contain any ejected material , Appropriate PPE - safety glasses.

  • Moving Machinery

  • State your additional control measure. This could be erecting barriers for pedestrian only routes, additional guarding on machinery.

  • Sharp Edge

  • State your additional control measure. This could be placing protective caps on sharp edges, Appropriate PPE - gloves.

  • Hot Surface

  • State your additional control measure. This could be erecting a shade barrier, Appropriate PPE - gloves , cooling fans or waiting until the surface is cool enough to be worked on.

  • Vehicle ( Mobile work equipment )

  • State your additional control measure. This could be erecting barriers for pedestrian only routes, Appropriate PPE - high viz, work in conjunction with other contractors or colleagues when it's suitable to carry out your work so the hazard is eliminated.

  • Working at height

  • State your control measure. This could be the use of a MEWP or erecting scaffold including fall restraints and harnesses. Erect barriers around working area to ensure the ''drop'' zone is clear of pedestrians.

  • Fumes / Gases / Vapours

  • State your additional control measure. This could be forced ventilation, sufficient time allowed for gas , fumes etc to dissipate, gas monitor to be worn or remove the hazard.

  • Chemical

  • State your additional control measure. This could be removing the chemical from the area , appropriate PPE - overalls , gloves , safety glasses .

  • Confined Space

  • This will require an additional separate risk assessment - emergency rescue plan, trained personnel. Call your manager immediately.

  • Biological

  • State your control measure. This could be removing the hazard to a sharps bin , remove the hazard, appropriate PPE to be worn - safety glasses , gloves , FP2 / FP3 mask and overalls.

  • Equipment

  • State your additional control measure. This could be completing a pre-use check, only trained personnel to use equipment.

  • Hand tools

  • State your additional control measure. This could be - only trained personnel to use hand tools, complete a pre-use check, barrier off the area and follow the manufactures instructions.

  • Electricity

  • State your additional control measure. This could be - only registered contractors carry out any electrical inspection , testing , repair or maintenance. Follow specific DSR rules is applicable, Only trained employees to work on any electrical system, isolate.

  • Weather

  • State your additional control measure. This could be avoiding working in direct sunlight, keep skin and head covered at all times, use dark lens safety glasses, erect protective tent.

  • Lighting

  • State your additional control measure. This could be erecting lighting towers to provide more light, head torches or wearing dark lens safety glasses if the light is to bright.

  • Fire

  • State your control measure. This could be removing any combustibles from the area, erect welding barriers , following the hot works permit precautions set out.

  • Manual Handling

  • State your additional control measure. This could be the use of mechanical aids , regular breaks, follow good manual handling techniques.

  • Noise

  • State your additional control measure. This could be wearing suitable PPE - ear defenders, changing the equipment being used to electric.

  • Vibration

  • State your control measure. This could be following manufactures guidelines for vibration time exposure, regular breaks, using anti vibration gloves.

  • Temperature

  • State your additional control measure. This could be taking regular breaks , staying hydrated, drinking warm or cool drinks, use of AC units / fans.

  • Violence

  • Remove yourself from the situation and contact the police and manager immediately.

  • Fibres / Dust

  • State your control measure. This could be the use of dust suppression systems such as water , mist. Wear suitable PPE - FP2 / FP3 mask, overalls. Extraction system to be used.

  • Waste

  • State your additional control measure. This could be wearing suitable PPE - gloves , safety glasses . Removing the waste , regular hand washing .

  • Oil

  • State your additional control measure. This could be the use of a bung or spillage control. Suitable PPE - gloves , overalls and safety eyewear. Consult the MDS sheet for storage information.

  • Fuel

  • State your additional control measure. This could be keeping the fuel away from the working area , suitable spillage control and PPE in place - gloves , eye wear. Fire extinguisher locally.

Part 3

  • IMPORTANT : Where the additional risk is significant STOP working and report to your manager. Nothing is to important that it cant be done safely and you get home safe.

  • Has any additional hazards been identified and control measure been put in place?

  • The working party acknowledges any additional safety provisions which shall be maintained throughout the course of the work.

  • Contact your manager immediately

  • Lead Operative

  • Operative

  • Operative

  • Operative

  • Provide completion photographs

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.