Title Page
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Work Order Number
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Conducted on
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Prepared by
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Location
Working at Heights
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What work are you performing?
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General question about the site
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Finish
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General Questions about the site
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Are you using Ladders?
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Ask another question
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Are you using EWP?
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Ask another question
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Are you entering restricted space areas?
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Finish
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General question about the site
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Are you using ladders?
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Ask another question
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Are you using EWP?
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Ask another question
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Are you entering restricted space areas?
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Finish
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General questions about the site
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Are you using ladders?
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Ask another question
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Are you using EWP
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Ask another question
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Working on roof?
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Working Outdoors
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Working around mobile plant
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Finish
Section 1: Risk Assessment
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Has the Site Induction been completed
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STOP WORK - Complete site Induction before starting work.
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Have you signed into the site Yes
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STOP WORK - Sign into the site before starting work.
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Are you wearing required PPE (Gloves/Boots/Eye Protection)
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STOP WORK - All required PPE must be used/present before starting work.
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Are you Fit for Work ? Not Under Influence of Drugs or Alcohol?
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Is the Work Area safe ? Exclusion Zones, clean & Tidy?
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Is the area secure from other trades/public?
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Are the tools safe (Guards in place, Test/Tagged, working as designed).
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Damaged Tools or Tools without Guards CANNOT be used
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Are you competent to perform the works.
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Have you checked site paperwork for permit requirements and an Asbestos Register ?
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STOP WORK - You must check for an Asbestos Register before starting work.
Section 2: Competence and SOP
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REFRESHER - Review SOP Electrical Work
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REFRESHER - Review SOP Working with EWP
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Are you competent to perform the work Activity?
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Section 3: High Risk Work Activities - SWMS
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Are you Working at Heights with EWP
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Review the EWP Safe Work Method Statement
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Is there any additional Controls Required?
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List Additional Controls
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Confirm you have been consulted on SWMS and will follow the safety controls.
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Are you Working at Heights with Trestles
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Is there any additional Controls Required?
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List Additional Controls
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Confirm you have been consulted on SWMS and will follow the safety controls.
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Are you performing Electrical Works
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Is there any additional Controls Required?
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List Additional Controls
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Confirm you have been consulted on SWMS and will follow the safety controls.
Section 4: Emergency Preparedness
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Do you have a First Aid Kit nearby.
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Do you have a Fire Extinguisher nearby
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Do you know the nearest Doctor/Hospital?
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**** Find the nearest Doctor Hospital before re-answering this question.
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Have you reviewed the exits from your location
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**** Find the nearest Exits before re-answering this question
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Do Not Start Work if you feel unsafe or not able to perform the works correctly. Call Zara on 0400 729 925
Section 5: Consultation
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Communicate the Work Activity to the other team members
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Instruct the Team on the Work Activity and re-assess
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Inform the Team Members they must follow SOP and SWMS
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Instruct the Team on the Work Activity and re-assess
Section 6: Approval
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I will follow all Safe Working Instructions/SOP's and Emergency Procedures while performing my work activities.
