Title Page
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Conducted on
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Prepared by
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Project Name
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Location
Site Team
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Project Manager
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Site Manager
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Site Supervisor
Minimum Requirement For Personal Protective Equipment
Additional PPE Relating to Specific Task Today
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Lifeline/Harness
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Please make sure you carry out inspection before use and log information on correct sheet.
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Over Goggles
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Face Shield
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Chemical Protection
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Respirator
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Please make sure you carry out inspection before use and log information on correct sheet.
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Hearing Protection
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Other
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What other protection is required ?
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List other PPE
Task Sequence
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Job Steps
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Take a picture to show works to be carried out
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Are there any potential hazards
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Please list all potential hazards
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People At Risk
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Critical actions to mitigate hazards
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Once task completed, take a picture to show area is clear
Acceptance Sign Off
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Project Manager
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Site Manager
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Site Supervisor
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If required ask the client to sign to agree to daily sequence
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Client Representative
Operatives Sign On
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We the undersigned have been fully briefed and understand the daily tasks and sequences.
Operative
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Add signature