Title Page

  • Date & Time

  • Prepared by

  • Location
  • PID

  • Have all personnel attended site induction and signed on to relevant SWMS?

  • Are all personnel wearing correct PPE for the specific tasks as per the SWMS?

  • Are there any slips, trips and falls impacting on the safe access and egress? (Check mechanically excluded areas)

  • If answer is yes, please list

  • Location of evacuation point?

  • Is first aid box located nearby in main vehicle?

  • Is there a risk of injury due to falls?

  • If answer is yes, please list

  • Are there any biological risks (sewage, needles, dumped hazardous waste etc)?

  • If answer is yes, please list

  • Is there a risk of anything falling (old branches, rock fall etc)?

  • If answer is yes, please list

  • Is there a risk of workers or pedestrians being struck by moving plant or vehicles?

  • If yes, please list

  • Are hazardous/dangerous substances used and stored according to their safety data sheets?

  • Are there any parts of the site that are sloping or near open water such as dams that could cause a roll over?

  • if answer is yes, please list

  • Is there a risk of injury due to impaling hazards such as star pickets or steel red bars in work area?

  • If answer is yes, please list

  • Have any manual handling risks been identified and accessed?

  • Is there a risk of injury due to open trenches or excavation?

  • If answer is yes, please list

  • Is there a risk of workers coming into contact with overhead or underground services?

  • If answer is yes, please list

  • Have pre start checks been carried out on all plant and equipment?

  • Are fire extinguishers in immediate vicinity of works especially at refuelling areas?

  • Are current weather conditions acceptable to carry out weed spraying? (NOT TO BE CARRIED OUT IN WINDY CONDITIONS)

  • Do all personnel have adequate sun protection (hats, sunscreen, shade etc) and drinking water on site?

  • Have you consulted with workers about the various tasks and the safe way to do them?

SIGN OFF

  • SUPERVISOR NAME

  • EMPLOYEE 1 NAME

  • EMPLOYEE 2 NAME

  • EMPLOYEE 3 NAME

  • EMPLOYEE 4 NAME

  • EMPLOYEE 5 NAME

  • EMPLOYEE 6 NAME

  • EMPLOYEE 7 NAME

  • EMPLOYEE 8 NAME

  • EMPLOYEE 9 NAME

  • EMPLOYEE 10 NAME

  • EMPLOYEE 11 NAME

  • EMPLOYEE 12 NAME

  • EMPLOYEE 13 NAME

  • EMPLOYEE 14 NAME

  • EMPLOYEE 15 NAME

  • EMPLOYEE 16 NAME

  • EMPLOYEE 17 NAME

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.