Title Page

  • Contractor Name

  • Conducted on

  • Prepared by


  • Current Public Liability Insurance Policy

  • Please do not proceed with the engagement of this contractor

  • Current Workers Compensation Policy

  • Other?

Licenses / Qualifications

  • Are licenses/qualifications required for the tasks being undertaken?

Risk Assessment

  • Has the Contractor provided a safe system of work (Risk Assessment or SWMS)?

Emergency Planning

  • Does the task require a specific emergency plan? (e.g. working with harnesses)

  • Will the site emergency plan be sufficient?

  • Please do not engage the contractor

Equipment and Machinery

  • Is all equipment / machinery in good working condition?

  • Is there a maintenance register of the machinery being brought to site?

Hazardous Chemicals

  • Will the task involve the use of hazardous chemicals?

  • If Yes, ensure containers are clearly labelled and Safety Data Sheets are available

Electrical Testing

  • Will electrical equipment be brought to site?

  • If yes, provide a copy of the electrical testing record

Training of workers

  • Will other workers be brought to site?

  • Please provide the details of all other workers who will be brought on site.

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.