FORM-304C LONE WORKING RISK ASSESSMENT - Working from Home (home based)

• Date conducted on

  Date

• Workers Name (the person that is lone working)

• Workers Position / Role

• Risk Assessment Completed by

• Assessors Position / Role

• Description of the Lone Working (e.g., Retail, Sales Rep, Home-Based) & frequency of the lone working:

• Site conducted (for Retail Sites only)

  Select

WORK ENVIRONMENT & CONDITIONS

• The working environment is free from any known hazards (e.g., physical risks, security risks, electrical hazards)?

  Yes

  No

  N/A

• Has the work environment been inspected for safety hazards (slips, trips, fire risks, electrical risks) in the last 6-months?

  Yes

  No

  N/A

PSYCHOSOCIAL RISKS

• Has the worker actively communicated that they feel comfortable and supported in managing stress and mental health related to lone working? If ‘no’, requires follow-up actions

  Yes

  No

  N/A

• Are there measures in place to reduce isolation (e.g., regular check-ins, communication with team members)?

  Yes

  No

  N/A

• Has the worker been given the opportunity to work from the company office & there is a dedicated desk available if they wish to?

  Yes

  No

  N/A

HEALTH & MEDICAL RISKS

• Is the worker free from any medical conditions that may be affected by lone working?

  Yes

  No

  N/A

• Does the worker know how to report accidents or near misses?

  Yes

  No

  N/A

ERGONOMIC AND PHYSICAL RISKS (Home-Based Workers)

• Has the worker completed an ergonomic self-assessment for their home workstation?

  Yes

  No

  N/A

• Is the home workspace set up with proper ergonomic equipment e.g., adjustable chair, monitor, keyboard, wrist supports (if required), gel-mouse pad (if required)?

  Yes

  No

  N/A

• Has the worker agreed that they take regular breaks to avoid prolonged sitting or repetitive strain (no longer than 2-hours at a time at the computer maximum)?

  Yes

  No

  N/A

COMMUNICATION

• Are there established protocols for regular check-ins or status updates?

  Yes

  No

  N/A

• Has the worker received a copy of the latest HSE Committee meeting minutes?

  Yes

  No

  N/A

TRAINING & AWARENESS

• Has the worker received the ‘EAP support services‘ Toolbox talk in the past 12-months?

  Yes

  No

  N/A

• Has the worker been provided with a copy of the Lone Working Guidelines (Guide-305) and they have indicated it has been read?

  Yes

  No

  N/A

• Has the worker received the ‘Psychosocial risks’ Toolbox talk in the past 12-months?

  Yes

  No

  N/A

• Has the worker received the cybersecurity training?

  Yes

  No

  N/A

Sign-Off

• Signature of person completing the risk assessment

  Sign

RISK RATING

• Scores Risk Rating: Score of 0-2 = Low Risk (the manager must address the deficiencies within a reasonable timeframe) Score of 3-4 = Medium Risk (Requires action within 2-weeks to address the deficiencies) Score of 5-7 = High Risk (require immediate actions to address the deficiencies) Score of 8 or more = Extreme Risk (require immediate actions to address the deficiencies) Check the checkbox to indicate that you will complete the required actions as per the timeframes shown above. Note you will have to complete the audit for the overall score to be shown in the report.