PREMISES RISK ASSESSMENT

  • no label

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:

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