Title Page
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Site conducted
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Conducted on
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Review Team
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Location
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Document Reference
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Description of Activity
Questions
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Did the team have an input into the production of the plan?
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If no, state why?
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Is the plan practical and generally suitable for the task?
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If no discover why?
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Has the team the right information, equipment & resources to complete task?
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If no what’s missing or needed? (materials, equipment, competence etc)
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Has anything changed in the location that makes the task more difficult?
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If yes, what has changed and what is the solution?
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Is there a safer more efficient way to complete the activity?
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If yes, what would it be?
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Are the correct permits, authorisations in place and any hold points understood?
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If no, what is missing?
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Considering, housekeeping, access / egress, exclusion etc, is there anything that could be improved?
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If yes, what would it be?
Summary - Generally, summarise the review identifying innovation, issues and solutions required for the activity to proceed safely
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Actions
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Action
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Action
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Action
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Action
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Action
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Signatures
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Name and Role
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Name and Role
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Name and Role
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Name and Role
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Name and Role
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Name and Role
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Name and Role
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Name and Role
