Title Page

  • For standard activities this must be: reviewed daily or when tasks or activities change.

  • Conducted on:

  • Prepared by:

  • Site Location:

Site Information

  • More complex higher risk sites and unique tasks, may require additional risk management - check with the foreman/supervisor or responsible manager.

  • Job number:

  • TMP number:

  • Client:

  • Person in charge:

  • STMS:

  • Have all subcontractors been inducted to site?

  • Induct them before they start work - https://fultonhoganknowhow.co.nz/subbie-induction-nz/ (subcontractor induction video)

  • All subcontracted and hired plant is inducted and stickered?

  • Do not use and check with the person in charge - https://fultonhoganknowhow.co.nz/wp-content/uploads/2021/03/GoTosubcontractedandhiredinplantFFL.pdf (Subcontracted and hired in plant info)

Medical, fires, spills and emergency

  • Emergency contact:

  • First aid kit location:

  • Fire equipment location:

  • Spill kit location:

  • Assembly point:

  • Hospital / clinic location:

  • First aider(s):

  • Other information:

  • Permit Type - Expiry dates
  • Permit type:

  • Expiry date:

  • Production targets, quality and environment requirements

  • Other - Please state:

  • Expiry date:

  • Production targets, quality and environment requirements

  • Resolving Issues
  • What issues did we have yesterday?

  • How will we fix them today?

Plan for the day

  • undefined

Online Information

  • https://fultonhoganknowhow.co.nz/ (KnowHow videos and other info - min requirements)

Site sketch, plan map or image

  • Risk prompts: moving plant, falls/height, traffic, trenching and excavation, lifting, confined space, manual handling, safe hands, fatigue, asbestos, noise/dust, temporary works, lockout tagout, environmental, discharge to air/land/water, quality.

  • Add info

  • Tasks, Risks and Controls
  • Tasks...What am I doing?

  • Risks...What could go wrong?

  • HSW / Q&I / E&S:

  • Controls...How do I do it safely?

  • FH Risk Matrix

    FH Risk matrix.PNG
  • Final Risk Rating:

  • PAUSE and check with foreman/supervisor and responsible manager

Minimum site and task based PPE

  • FH Updated PPE.PNG
  • PPE required (tick all that apply)

  • RT Radio Channel

  • Other PPE required

Risks reviewed

  • Risks reviewed:

  • Risk register: https://fultonhoganknowhow.co.nz/wp-content/uploads/2022/04/Risk-Register-NZ.pdf

  • Review the following questions and sign on before starting work
  • Full name:

  • Date:

  • Company:

  • Who did you travel with?

  • Phone:

  • Fit and well for the work day ahead?

  • PAUSE and check with Foreman/Supervisor or Responsible Manager

  • Understand the controls? HSW, Q&I, E&S

  • PAUSE and check with Foreman/Supervisor or Responsible Manager

  • Inducted onto this work site?

  • PAUSE and check with Foreman/Supervisor or Responsible Manager

  • Trained and competent in your tasks?

  • PAUSE and check with Foreman/Supervisor or Responsible Manager

  • Wearing the correct PPE?

  • PAUSE and check with Foreman/Supervisor or Responsible Manager

  • Sign on

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.