Title Page
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Document No.
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Employee
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Conducted on
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Location
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Prepared by
Assessment Info
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Job Number
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Assessment Reason
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Assessment Type
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Location Type
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Type of work
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Details:
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Brief description of work
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Appropriate competencies / ID card available and in date (eg. SHEA/CSCS)?
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Comments
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Risk Assessment carried out prior to starting task?
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Comments
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Appropriate PPE in use on task?
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Comments
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Plans/Drawings/info requested?
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Comments
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Third Party services located/marked, prior to starting task?
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Comments
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Safe System of Work incl Trench support installed where appropriate for excavations?
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Comments
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Safe Working - Engineer risk?
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Comments
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Safe Working - Customer/third party risk?
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Comments
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Correct Use of barriers/warning signs?
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Comments
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Appropriate machine selected and used?
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Comments
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Precautions taken to prevent manual handling injuries?
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Comments
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"Volt stick" check on appliance / equipment carried out. (incl adjacent equipment/surfaces)?
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Comments
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230v/110v electrical equipment condition and evidence of test/inspection?
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Comments
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230v/110v electrical equipment in use in an unsafe condition &/or without test evidence?
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Comments
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Equipment calibrated and in date, e.g. multi meter, gas detector, Cable avoidance tool etc?
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Comments
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SOK 34 used to check electrical socket (and checked correct operation)?
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Comments
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Uses personal RCD (and checked correct operation)?
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Comments
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Asbestos safety precautions taken?
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Comments
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Safe System of work for Working at Height followed - Ladders and Access Systems?
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Comments
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All access equipment has been asset tagged or is easily identifiable. Evidence of inspections?
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Comments
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Fall restraint/arrest and harness equipment available, stored safely and fit for purpose?
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Comments
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Safe system of work for confined space entry?
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Comments
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Safe use and maintenance of high pressure water jetting equipment?
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Comments
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Safe system of work for lining and/or CCTV?
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Comments
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All waste handled correctly/removed from site - incl Hazardous materials?
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Comments
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Reinstatement carried out correctly?
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Comments
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Paperwork completed correctly and left with customer?
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Comments
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Incident reporting – if nothing to report does the employee understand the reporting process etc?
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Comments
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Is the Vehicle Safety / Storage in general good condition?
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Comments
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Suitable PPE available and fit for purpose?
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Comments
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Appropriate HS&E documentation available.
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Comments
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Suitable Tools available and in use for the, task incl controls for cross contamination?
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Comments
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Spillage kit available?
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Comments
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Working to Standards?
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Comments
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Overall Attitude towards safe working
Signoff
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Assessor - I confirm that the information I have collated is a true representative of my findings, and any failures have been recorded, resolved onsite using the comments box or actions raised for the appropriate member of staff.
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Assessed Employee - I confirm that the assessor has provided me with feedback on this assessment. I understand any actions / improvement notices that have been given to me.
