Title Page

  • Conducted on

  • Prepared by

  • Location
  • Company name

  • Address of Site
  • Select date

PART 1 STOP!

  • Are you at the correct site, item of plant or location?

  • Do you have the right documentation for the job?

  • Do you have the right PPE for the job?

  • Are power tools and leads and plant tested?

  • Are the deep open voids boarded over

  • Is lifting equipment inspected?

  • If you have answered ‘No’ to any of the above, take the required action or report to your supervisor. If in doubt always ask!

  • Any Amplifying Information

Safety and health assessment (If the hazard is present tick the box)

  • Falls from height

  • Falling or flying objects

  • Confined spaces

  • Electric Welding

  • Gas Welding

  • Soldering/Brazing

  • Pressure testing

  • Abrasive Wheels

  • Lone working

  • Dust

  • Recovering Refrigerant

  • falls on the same level

  • Entry into a confined space

  • Fumes/ Gas

  • Heat/ Cold

  • Noise/ Vibration

  • Hand tools

  • Manual handling

  • Poor lighting

  • Hot Works

  • Working on roof/s

  • Ladders/Steps

  • Working in Riser/ Shafts

  • Lifting operations

  • Flying particles

  • Electricty

  • Falls of material

  • Work on/adjacent to water

  • Mobile Towers

  • Any Other Risks (Please state)

  • Any Other Risks

  • Add media

  • Rescue Plan Rescue from Scaffold Ladder Rescue If a mobile elevating work platform is not available, use ladders to rescue the fallen worker with the procedure outlined below. If the fallen worker is suspended from a lifeline, move the worker (if possible) to an area that rescuers can access safely with a ladder. Set up the appropriate ladder(s) to reach the fallen worker.Rig separate lifelines for rescuers to use while carrying out the rescue from the ladder(s).If the fallen worker is not conscious or cannot reliably help with the rescue, at least two rescuers may be needed.If the fallen worker is suspended directly from a lanyard or a lifeline, securely attach a separate lowering line to the harness.Other rescuers on the ground (or closest work surface) should lower the fallen worker while the rescuer on the ladder guides the fallen worker to the ground (or work surface).Once the fallen worker has been brought to a safe location, administer first aid and treat the person for suspension trauma and any other injury.Arrange transportation to hospital if required. Rescue from MEWPS Failure of upper control functions while elevated Where the normal upper control functions fail, the operator will use the auxiliary controls from the platform to lower the boom safely to the ground Failure of the operator to be able to operate the MEWP functions while elevated due to the following reasons:- A. Operator incapacitated B. Auxiliary functions fail to operate from upper control station Where the operator is incapable of lowering the MEWP using the upper controls, an appointed person familiarised in the use of the lower 'ground' controls will lower the platform safely to the ground using the lower ground controls Failure of lower ground controls Where the lower ground controls fail to allow the boom to be lowered safely to the ground, the appointed person will use the auxiliary ground controls to lower the boom safely to the ground Failure of ALL normal and auxiliary lowering functions Where all normal and auxiliary functions have failed, the appointed person on the ground should refer to BS8460 section 6.6 Rescue from height

Additional safety assessment

  • Hazard

  • Control measures or precautions

  • Remaining risk

End of job review

  • Are there any lessons for next time?

  • Lessons Learnt

  • Has the work created any new hazards?

  • New Hazards

  • Lessons learnt and future site or location visit advice (list here any information that would make the next visit safer and include contact details if appropriate)

  • iBEMS Director Signature

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.