Title Page

  • Date:

  • Project:

  • Client / Site

  • Location
  • Prepared by

  • Personnel

  • First Aider/s:

  • Emergency Evacuation Point:

  • Nearest Medical Facility / Hospital:

  • Emergency Equipment Location:

PPE

  • Site Specific Personal Protective Equipment (PPE) Required

  • Additional PPE:

Permits and Plant Equipment

Permits and Plans

  • Confined Space Entry

  • Working at Height

  • Excavation and Drill

  • Isolation

  • Hot Work

  • Environmental / Land Access

  • Workbox

  • Other:

Plant and Equipment

  • Pre-start inspection completed on plant?

  • Lifting gear inspected and tagged?

  • Electrical gear tested and tagged?

  • Plant risk assessed, inducted, and accepted?

  • Climbing equipment (including ladders) inspected?

  • Fall arrest equipment inspected?

  • Safety detection (E.G Radman) equipment operational/calibrated?

  • Other:

  • Other:

Tasks

What are the tasks we are doing today?

  • 1.

  • 2.

  • 3.

  • 4.

  • 5.

Hazards

    Add a Hazards
  • What are the key risk controls to be implemented?

  • What are the key hazards?

  • Who is responsible?

  • Critical Risk?

  • Note SHEWMS reference no.

Additional considerations

  • Are there any other factors that can affect your work area (i.e. other work crews)? [Note Below]

  • Please list:
  • undefined

Competencies

Competencies required to complete task (including verification of competency)

    Add Competencies
  • Name:

  • Competency:

  • Ticket number:

  • VOC Required?

  • Upload evidence

Discussion

  • Are there any incidents, injury concerns, hazard alerts, SHEQ alerts, directives, positive events/news, etc. that require discussing?

  • Add comment
  • undefined

Specific Topics/issues raised:

    Add topic/issue:
  • Topic / Issue:

  • Comment or Action:

Emergency Plans:

  • Emergency response plans communicated and well understood by all workers onsite?

Induction / Onboarding / Training / Competency:

  • All workers have been on-boarded/inducted appropriately and are trained and competent to complete all tasks?

Changes to design/plans:

  • Have changes to approved design / construction plans been assessed for risk and communicated to workers?

Weather forecast:

  • Morning:

  • Afternoon:

Pre-start Sign on

Pre-start Sign on

  • I, the undersigned, hereby certify that I have been inducted to this job site by Visionstream or Site Supervisor, and that I have actively participated in the identification of hazards, assessment and control of risks associated with working at this location by way of this pre-start briefing. I agree to implement the control measures identified, including the use of the appropriate PPE:

  • Add person:
  • Name and Signature:

  • Company:

  • Phone number:

  • Start:

  • Finish:

Authorising signature

  • I certify that this form was completed prior to commencing work on this site, and that all workers and visitors have been inducted to site:

  • Name and signature:

  • Position:

  • Date:

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.