Engineering / Maintenance - Dynamic Risk Assessment

• Site conducted

  Select

• Date & Time

  Date

• Contractor Company Name

• Machine/Asset Name to Repair/Service

• Accompanied By: (If Required)

• Does the work involve entering the production rooms, counters or cafes? if yes complete Medical Questionnaire

  Yes

  No

MEDICAL QUESTIONNAIRE

• Sickness / vomiting?

  Yes

  No

• Diarrhoea?

  Yes

  No

• Abdominal pains?

  Yes

  No

• Recurring bowel disorder?

  Yes

  No

• Conditions of the skin, hands, arms or face?

  Yes

  No

• Boils, sties or septic finger?

  Yes

  No

• Discharge from eye, ear, gums or throat?

  Yes

  No

• Are you suffering from a heavy cold or flu?

  Yes

  No

• Have you been in contact with anyone who may have been suffering from enteric fever e.g. Typhoid, Paratyphoid, Hepatitis or any other gastro-intestinal illness?

  Yes

  No

• Have you visited any of the known countries to have had an outbreak of the Coronavirus in the last month?

  Yes

  No

• Do you have or have had any respiratory symptoms, fever, cough, shortness of breath and breathing difficulties in the last 14 days?

  Yes

  No

• Are you required to carry medicines which we should be made aware of?

  Yes

  No

• Do you have any known food allergies?<br>Allergens are handled in some of our manufacturing departments. We advise allergy sufferers not to enter the manufacturing departments.<br>

  Yes

  No

• Have you read the Sites Visitor / Contractor - Personal Hygiene Procedure? On reverse

  Yes

  No

  N/A

• If you answered "yes" to any question (other than 10, 11, 12 & 13), provide details:

Hygiene Declaration

• I have read the Personal Hygiene Rules & have removed all jewellery and watches.

  Agree

• I have read the department Allergen Control document (Only required if entering manufacturing departments).

  Agree

• Contractors Only - My tools / equipment are clean & free from contamination.

  Agree

  Not Required

• Contractors Only - My oils / greases / lubricants etc. are food grade & allergen free. <br>I can provide Safety Data Sheet’s if requested.<br>

  Agree

  Not Required

• I declare that to the best of my knowledge the information provided is true.

  Agree

• Contractor Print Name & Sign

  Sign

• Brief description of the work

Work Permits

• The following work must only be carried out under a permit to work. CONFINED SPACES / WORK
  ING AT HEIGHT / HOT WORKS / Work MUST NOT commence until the appropriate permit has been completed.

• Does the work taking place require a permit to work

  Yes

  No

• Please select from the list below the relevant permit

  Confined Spaces

  Working at Height

  Hot Works

Confined Spaces

Section A - Preparation

• Please confirm that a risk assessment along with method statement (RAMS) has been submitted and approved by the Estates /Safety Team

  Yes

  No

• Do not proceed and contact Estates/Safety Team, detail actions taken

• Proposed work to take place ( to be completed by the person conducting the works)

• Exact location of the proposed work

• What time is the work taking place?

  Date

• Will there be any production or work activity taking place in the area?

  Yes

  No

• The access to the confined space has been protected and is visible to all colleagues working in the areas

  Yes

  No

  N/A

• Do not proceed until area is made safe, detail actions taken

• Is there a risk of dangerous fumes

  Yes

  No

• Do not proceed until area is made safe, detail actions taken

• The area has been isolated from Hydraulic power released

  Yes

  No

  N/A

• Do not proceed until area is made safe, detail actions taken

• The area has been isolated from sources of Electrical Power

  Yes

  No

  N/A

• Do not proceed until area is made safe, detail actions taken

• The area has been isolated from Steam or heat

  Yes

  No

  N/A

• Do not proceed until area is made safe

  Yes

  No

  N/A

• Number of workers authorised to work under this permit? (must always be more than 1)

• All preparation is now complete, name of authorised person for the work

• Add signature

  Sign

• Select date

  Date

Section B -Atmospheric Tests

• Has the confined space been identified at being at risk from poisonous gases, fumes or vapours

  Yes

  No

• Test taking place

• The atmosphere has been found to be satisfactory for the work to be carried out with or without breathing apparatus.

  with

  without

• The area will be retested

  Date

• Name of competent person undertaking tests

• Please sign

  Sign

• Date and time

  Date

• Company

Section C - Safety Precautions

• In addition to isolation procedures listed above in Part A the following precautions have been taken:

• Breathing apparatus

  Yes

  No

  N/A

• Lifebelt and rope held on the outside of the confined space

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Protective clothing

  Yes

  No

  N/A

• Dust Respirator

  Yes

  No

  N/A

• Non sparking approved tools

  Yes

  No

  N/A

• Exhaust Fan

  Yes

  No

  N/A

• Others (specify)

  Yes

  No

  N/A

• All preparation is now complete, name of authorised person for the work

• Add signature

  Sign

• Select date

  Date

SIGN & DATE - Pre work

• Sign and confirm that all details are correct, that both parties are happy with the controls in place and that the work is authorised to commence

• Contractor Print Name & Signature

  Sign

• Site or Store Management Print Name & Signature

  Sign

Working at Height

Section A - Preparation

• Proposed work to take place ( to be completed by the person conducting the works)

• Exact location of the proposed work

• Is the work taking place during operating hours?

  Yes

  No

• Has the area been made safe and relevant control measures implemented?

  Yes

  No

• Do not proceed, discuss with site management team, detail actions taken

• Number of workers authorised to work under this permit?

Section B -Equipment to be used

• Detail equipment to be used

  Select Ladder Mobile Elevating Work Platform (MEWP) Scaffolding other

  • Ladder
  • Mobile Elevating Work Platform (MEWP)
  • Scaffolding
  • other

• Please detail

• Please confirm all colleagues using the equipment have been trained and hold the relevant certification

  Yes

  No

• Do not proceed, discuss with management team, detail actions taken

Section C - Roof Work

• Does the work involve working on the roof?

  Yes

  No

• Is there any on site safety systems such as cable/harness or edge protection

  Yes

  No

• Please detail type

  Edge Protection

  Cable/harness system

• Will this be used and if so are colleagues fully trained

  Yes

  No

• WARNING - Edge protection not safe and must not be used as a control

• Has a risk assessment for roof work been submitted and approved by the Estates/Safety Team

  Yes

  No

• Do not proceed and discuss with site management, detail actions

SIGN & DATE - Pre work

• Sign and confirm that all details are correct, that both parties are happy with the controls in place and that the work is authorised to commence

• Contractor Print Name & Signature

  Sign

• Site or Store Management Print Name & Signature

  Sign

Hot Works

• Proposed work to take place ( to be completed by the person conducting the works)

• Exact location of the proposed work

Equipment

• Equipment for the hot work has been checked and found to be in good repair

  Yes

  No

  N/A

• Do not proceed, discuss with site management, detail actions

Fire Protection

• Continuous fire watch must take place for a least one hour after work ceases, in the work area and those adjoining areas to which sparks and heat that may have spread.

  Yes

  No

  N/A

• At least two suitable extinguishers are immediately available and the person is competent in their use

  Yes

  No

  N/A

• Do not proceed and discuss with onsite management, detail actions taken

• Personnel involved with the work and providing the fire watch are familiar with the means of escape and method of raising the alarm/calling the fire brigade.

  Yes

  No

  N/A

• Do not proceed and discuss with on site management, detail actions taken

Precautions within 10m

• Combustible materials have been cleared from the area. Where materials cannot be removed, protection has been provided by non combustible or purpose made blankets, drapes or screens

  Yes

  No

  N/A

• Please detail actions taken

• Flammable liquids have been removed from the area

  Yes

  No

  N/A

• Please detail actions taken

• Where sprinklers are installed has precaution been taken to protect the sprinkler head from direct heat

  Yes

  N/A

• Are there any heat or smoke detectors, if so request through duty/site manager to take system off watch for the duration of the works

  Yes

  No

  N/A

• Floors have been swept clean

  Yes

  No

  N/A

• Please detail actions taken

• All openings and gaps should be adequately covered where there is a risk of sparks passing

  Yes

  No

  N/A

• Do not proceed and discuss with site management, detail actions

SIGN & DATE - Pre work

• Sign and confirm that all details are correct, that both parties are happy with the controls in place and that the work is authorised to commence

• Contractor Print Name & Signature

  Sign

• Site or Store Management Print Name & Signature

  Sign

• Does the work taking place require an additional permit to work

  Yes

  No

• Please select from the list below the relevant permit

  Confined Spaces

  Working at Height

  Hot Works

Confined Spaces

Section A - Preparation

• Please confirm that a risk assessment along with method statement (RAMS) has been submitted and approved by the Estates /Safety Team

  Yes

  No

• Do not proceed and contact Estates/Safety Team, detail actions taken

• Proposed work to take place ( to be completed by the person conducting the works)

• Exact location of the proposed work

• What time is the work taking place?

  Date

• Will there be any production or work activity taking place in the area?

  Yes

  No

• The access to the confined space has been protected and is visible to all colleagues working in the areas

  Yes

  No

  N/A

• Do not proceed until area is made safe, detail actions taken

• Is there a risk of dangerous fumes

  Yes

  No

• Do not proceed until area is made safe, detail actions taken

• The area has been isolated from Hydraulic power released

  Yes

  No

  N/A

• Do not proceed until area is made safe, detail actions taken

• The area has been isolated from sources of Electrical Power

  Yes

  No

  N/A

• Do not proceed until area is made safe, detail actions taken

• The area has been isolated from Steam or heat

  Yes

  No

  N/A

• Do not proceed until area is made safe

  Yes

  No

  N/A

• Number of workers authorised to work under this permit? (must always be more than 1)

• All preparation is now complete, name of authorised person for the work

• Add signature

  Sign

• Select date

  Date

Section B -Atmospheric Tests

• Has the confined space been identified at being at risk from poisonous gases, fumes or vapours

  Yes

  No

• Test taking place

• The atmosphere has been found to be satisfactory for the work to be carried out with or without breathing apparatus.

  with

  without

• The area will be retested

  Date

• Name of competent person undertaking tests

• Please sign

  Sign

• Date and time

  Date

• Company

Section C - Safety Precautions

• In addition to isolation procedures listed above in Part A the following precautions have been taken:

• Breathing apparatus

  Yes

  No

  N/A

• Lifebelt and rope held on the outside of the confined space

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Protective clothing

  Yes

  No

  N/A

• Dust Respirator

  Yes

  No

  N/A

• Non sparking approved tools

  Yes

  No

  N/A

• Exhaust Fan

  Yes

  No

  N/A

• Others (specify)

  Yes

  No

  N/A

• All preparation is now complete, name of authorised person for the work

• Add signature

  Sign

• Select date

  Date

SIGN & DATE - Pre work

• Sign and confirm that all details are correct, that both parties are happy with the controls in place and that the work is authorised to commence

• Contractor Print Name & Signature

  Sign

• Site or Store Management Print Name & Signature

  Sign

Working at Height

Section A - Preparation

• Proposed work to take place ( to be completed by the person conducting the works)

• Exact location of the proposed work

• Is the work taking place during operating hours?

  Yes

  No

• Has the area been made safe and relevant control measures implemented?

  Yes

  No

• Do not proceed, discuss with site management team, detail actions taken

• Number of workers authorised to work under this permit?

Section B -Equipment to be used

• Detail equipment to be used

  Select Ladder Mobile Elevating Work Platform (MEWP) Scaffolding other

  • Ladder
  • Mobile Elevating Work Platform (MEWP)
  • Scaffolding
  • other

• Please detail

• Please confirm all colleagues using the equipment have been trained and hold the relevant certification

  Yes

  No

• Do not proceed, discuss with management team, detail actions taken

Section C - Roof Work

• Does the work involve working on the roof?

  Yes

  No

• Is there any on site safety systems such as cable/harness or edge protection

  Yes

  No

• Please detail type

  Edge Protection

  Cable/harness system

• Will this be used and if so are colleagues fully trained

  Yes

  No

• WARNING - Edge protection not safe and must not be used as a control

• Has a risk assessment for roof work been submitted and approved by the Estates/Safety Team

  Yes

  No

• Do not proceed and discuss with site management, detail actions

SIGN & DATE - Pre work

• Sign and confirm that all details are correct, that both parties are happy with the controls in place and that the work is authorised to commence

• Contractor Print Name & Signature

  Sign

• Site or Store Management Print Name & Signature

  Sign

Hot Works

• Proposed work to take place ( to be completed by the person conducting the works)

• Exact location of the proposed work

Equipment

• Equipment for the hot work has been checked and found to be in good repair

  Yes

  No

  N/A

• Do not proceed, discuss with site management, detail actions

Fire Protection

• Continuous fire watch must take place for a least one hour after work ceases, in the work area and those adjoining areas to which sparks and heat that may have spread.

  Yes

  No

  N/A

• At least two suitable extinguishers are immediately available and the person is competent in their use

  Yes

  No

  N/A

• Do not proceed and discuss with onsite management, detail actions taken

• Personnel involved with the work and providing the fire watch are familiar with the means of escape and method of raising the alarm/calling the fire brigade.

  Yes

  No

  N/A

• Do not proceed and discuss with on site management, detail actions taken

Precautions within 10m

• Combustible materials have been cleared from the area. Where materials cannot be removed, protection has been provided by non combustible or purpose made blankets, drapes or screens

  Yes

  No

  N/A

• Please detail actions taken

• Flammable liquids have been removed from the area

  Yes

  No

  N/A

• Please detail actions taken

• Where sprinklers are installed has precaution been taken to protect the sprinkler head from direct heat

  Yes

  N/A

• Are there any heat or smoke detectors, if so request through duty/site manager to take system off watch for the duration of the works

  Yes

  No

  N/A

• Floors have been swept clean

  Yes

  No

  N/A

• Please detail actions taken

• All openings and gaps should be adequately covered where there is a risk of sparks passing

  Yes

  No

  N/A

• Do not proceed and discuss with site management, detail actions

SIGN & DATE - Pre work

• Sign and confirm that all details are correct, that both parties are happy with the controls in place and that the work is authorised to commence

• Contractor Print Name & Signature

  Sign

• Site or Store Management Print Name & Signature

  Sign

FOOD HYGIENE

• Will the task involve working in an area with food hygiene requirements, which includes working within manufacturing department.

  Yes

  No

• Have the suitable segregations / controls been identified and incorporated into the work sequence?

  Yes

  No

• Do not proceed until segregation and controls have been identified

• Please describe:

ASBESTOS CONTAINING MATERIALS

• Will the work be intrusive? i.e. drilling / cutting?

  Yes

  No

• If yes to the above, are you fully trained in asbestos awareness?

  Yes

  No

• Do not proceed and contact the Estates Team for further instruction

• Are further precautions / controls required?

  Yes

  No

• Please detail:

POWER TOOLS

• Will power tools be used and are all colleagues using them fully trained/certified ?

  Yes

  No

• If yes to the above, are either battery operated tools or 110v supply being used for the task?

  Yes

  No

• Do not proceed and contact the Estates Team for further instruction

• Is the equipment in good condition?

  Yes

  No

• Do not use and contact the Estates Team for further instruction

MANUAL HANDLING

• Will the task involve manual handling?

  Yes

  No

• What mechanical lifting aids will be available?

HAZARDOUS SUBSTANCES

• Are any products being used classed as hazardous?

  Yes

  No

• Are safety data sheets detailing correct use, storage, handling and emergency procedures available and communicated?

  Yes

  No

• Do not proceed and contact the Estates Team for further instruction

• Has appropriate PPE been provided?

  Yes

  No

• Do not proceed and contact the Estates Team for further instruction

• Please list products being used:

• WARNING - No hazardous products to be left unattended or on site after completion

LIVE SERVICES

• Have any live services been isolated?

  Yes

  No

  Not Required

• Confirm arrangements for ensuring safety of contractor. Please detail:

FIRE SAFETY

• Will any of the planned work interfere with the existing fire precautions within the site / store? for example working in a fire escape route, storing equipment in a escape route, removal of doors, covering up of detection

  Yes

  No

• Confirm measures to be taken in conjunction with site / store management.

• Yes

  No

  N/A

PUBLIC PROTECTION

• Is work carried out in the vicinity of members of the public or Booths colleagues?

  Yes

  No

• If yes, please detail the security, control, segregation methods to be used

SIGN & DATE - Pre work

• Sign and confirm that all details are correct, that both parties are happy with the controls in place and that the work is authorised to commence

• Contractor Print Name & Signature

  Sign

• Site or Store Management Print Name & Signature

  Sign

RECORD OF REPAIR

• Select Area of Repair

  Riversway

  Riversway Warehouse

  Fresh Food Manufacturing

  Fresh Food Warehouse

  Ambient

• Summary of Repair

• State of Repair - If temporary, a permanent repair must be carried out in an agreed practical timescale.

  Permanent

  Temporary

  Not Applicable

• Timescale for permanent repair to be completed: (Please State)

• Parts required / Ordered?

  Yes

  No

  Not Applicable

• Detail parts required

• All parts accounted for and no further damage has been done to the machine?

  Yes

  No

  N/A

• All tools removed from the production area and are accounted for?

  Yes

  No

  N/A

• Repair Carried Out By? Engineer's Name & Signature

  Sign

• Name & Signature: (Manufacturing Production)

  Sign

• NOTE: All product contamination hazards MUST be removed by effective cleaning and MUST be completed by a trained member of staff prior to use.

Sign and Date - Post Work

• Sign and confirm that all work has been undertaken as agreed and that all areas are clean and fully operational

  Yes

  No

• Please select the next step

  Parts ordered

  Follow up visit agreed

  other

• please detail next steps

• Please confirm that the Fire Alarm if taken "off watch" has been put back "on watch"

  Yes

  N/A

• Contractor Print Name & Signature (Work Completed)

  Sign

• Site or Store Management Print Name & Signature (Work Completed)

  Sign