Title Page

  • Site conducted

  • Business unit

  • Conducted on

  • Prepared by

Emergency Checklist

Emergency Reponse Team

  • If you do not have adequate trained emergency response teams- answer None and report to the line manager

  • Who are the First Aiders available for this shift?

  • Who are Fire Wardens available for this shift?

  • W/H Who are the trained spill response available for this shift?

  • Who are the trained Drugs and Alcohol testers for this shift?

Safety Issues in last 24 hours

  • Have any safety issues been raised in the previous 24 hours

  • What is the safety issue?

  • Have any quality issues been raised in the previous 24 hours

  • What is the quality issue?

Staff

  • Are staffing levels at the required amount to perform all tasks safely?

  • Escalate to manager. Raise a POTential Action

Sign off

  • Name and signature

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