PREMISES RISK ASSESSMENT

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FAULT 1).

LOCATION OF FAULT:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 2).

LOCATION OF FAULT:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 3).

LOCATION OF FAULT:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 4).

LOCATION OF FAULT:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 5).

LOCATION OF FAULT:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 6).

LOCATION OF FAULT:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 7).

LOCATION OF FAULT:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 8).

LOCATION OF FAULT:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 9).

LOCATION OF FAULT:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 10).

LOCATION OF FAULT:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 11).
LOCATION OF FAULT:

LOCATION KNOWN AS:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 12).
LOCATION OF FAULT:

LOCATION KNOWN AS:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

CONTROLS APPLICABLE TO WORKS:
COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 13).
LOCATION OF FAULT:

LOCATION KNOWN AS:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 14).
LOCATION OF FAULT:

LOCATION KNOWN AS:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 15).
FLOOR LEVEL / INTERNAL / EXTERNAL:

LOCATION KNOWN AS:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media
FAULT 16).
LOCATION OF FAULT:

LOCATION KNOWN AS:

REPORTING:

NOTE: 'CRITICAL' items are priority and will require immediate attention!!

RECOMMENDED ACTIONS:

PRIORITY - TIME LINE:
ASSIGNED MANAGER: (Assigned to ensure task completed).

Please give more details to who needs to be contacted:

JOB ASSIGNED TO:

SAFETY NOTES:

COMPLETION DETAILS: (Office Use Only)
ACTIONED BY: Please Sign & Date.

ADDITIONAL NOTES:

FURTHER ACTIONS REQUIRED:

Add media

SIGNATURE OF INSPECTOR:
REVIEW SECTION. (To be Signed off following review)

DATE REVIEWED:

SITE MANAGER/CARETAKER SIGNED:

MANAGER OF SAFETY FOR SITE SIGNED:

PREMISES OFFICER SIGNED:

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.