Title Page
Job Start
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Work order no.
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Conducted on
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Which SWMS are relevant to your task?
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I have read, understood, and signed onto all relevant SWMS.
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I am aware of the location of the nearest first aid kit, fire extinguisher, and emergency exit.
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All plant, equipment, and tools have been inspected and are ready for use.
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Does the task require any PPE other than mandatory equipment?<br>(Long sleeve shirt & pants, and safety boots)<br>
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If yes, list required PPE:
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Can I be exposed to anything that may harm me?<br>(E.g. Being caught in or between anything; strain or overexertion; falls onto, into, or from anything; slip or trip on anything)
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If yes, list all hazards and controls:
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Does anything need to be isolated and tested for dead?<br>(E.g. Electricity, heat, gas, hazardous substances)
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If yes, list required isolations:
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List any additional hazards and controls, if any, not covered above:
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Signed
