HASS Form

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Add signature

  Sign

Employer Details:

• Employer's name:

• Number of employees:

• Nature of business:

• Add location
  Address

• Main contact: (Name & tel no)

• Health and safety contact:

• Type of work carried out at workplace location:

• Enforcement action: (Prosecutions, notices)

• Health and safety committee / safety representation:

• Risk category: (see table on page 4)

  High (future assessment to be carried out in 1 year (minimum))

  Medium (future assessment to be carried out in 2 yrs. (minimum)

  Low (future assessment to be carried outin 3 years (minimum))

The employer or their representatives: (Please sign to agree that this is an accurate record oft he assessment)

• Signed:

  Sign

• Job title:

• Select date

  Date

Funding organisation Assessment undertaken by:

• Name:

• Job title:

• H&S Qualification:

• Select date

  Date

Quality Assured by:

• Name:

• Job Title

• Select date

  Date

• Recommendation:<br>(See complete HASS for full details.<br>This is located in central file.

  accept

  accept with action plan

  Reject

Assessment Type

• Initial Assessment

• Re-assessment

• Other (please specify)

• Date of next assessment:

1. Health and Safety Procurement standard:

• Is there a clear commitment to health, safety & welfare (written policy statement mandatory when 5 or more employees)?

  Select Yes No

  • Yes
  • No

• Evidence / comments

• Add media

  Media

• Are the responsibilities for Health and Safety clearly stated ( recorded when 5 or more employees)?

  Yes

  No

• Evidence / comments

• Add media

  Media

• Are arrangements for health and safety clearly stated
  (Recorded when 5 or more employees)?

• Evidence / comments

• Add media

  Media

• How are the commitment, responsibilities and arrangements for health & safety (1A - 1c above) communicated to employees?

• Evidence / comments

• Add media

  Media

• Assessment of standard 1:

  Met

  Part met

  Not met

2. Risk assessment and control

• Have relevant risk assessments been carried out and significant risks identified?

• Evidence / comments

• Add media

  Media

• Have the significant findings and details of any groups identified as being especially at risk been recorded (this is optional where there are fewer than 5 employees)?

• Evidence / comments

• Add media

  Media

• Have control measures been identified and put in place as a result of the risk assessments?

• Evidence / comments

• Add media

  Media

• Do the risk assessments take into account learners who may have specific needs because of their circumstances. For example young people, (giving consideration to their inexperience, immaturity etc.), vulnerable adults, disabled (access etc)?

• Evidence / comments

• Add media

  Media

• Give details of the risks and control measures relating to the occupations and the specific activities carried out in the workplace.

• Evidence / comments

• Add media

  Media

• How are the risks and control measured explained to employees and others? Are procedures in place for employees that have difficulty understanding the spoken word e.g. English is not their first language, are deaf, have learning difficulties, etc.

• Evidence / comments

• Add media

  Media

• Are risk assessments reviewed e.g. In light of the findings from monitoring activities?

• Evidence / comments

• Add media

  Media

• Assessment of standard 2:

  Met

  Part met

  Not met

3. Accident, incidents and first aid

• Have adequate arrangements for first aid materials been made?

• Evidence / comments

• Add media

  Media

• Have adequate arrangements for trained first aid persons bee made?

• Evidence / comments

• Add media

  Media

• Are accidents and first aid treatments rendered recorded?

• Evidence / comments

• Add media

  Media

• Are or will all legal reportable learner accidents, incidents and ill-health be reported to RIDDOR & the learning provider for on pass to the appropriate funding agency. Will they also be investigated to enable suitable remedial action to be taken?

• Evidence / comments

• Add media

  Media

• How are the arrangements for accidents, incidents, ill-health and first aid made known to all employees?

• Evidence / comments

• Add media

  Media

• Assessment of standard 3:

  Met

  Part met

  Not met

4. Supervision, training, information and instruction

• Are employees provided with adequate competent supervision?

• Evidence / comments

• Add media

  Media

• Is initial health and safety information, instruction and training given to all new employees on recruitment?

• Evidence / comments

• Add media

  Media

• Is ongoing health and safety information, instruction and training provided to all employees?

• Evidence / comments

• Add media

  Media

• Is health and safety information, instruction and training records?

• Evidence / comments

• Add media

  Media

• How is the effectiveness of health and safety information, instruction and training assessed, and is the assessment recorded?

• Evidence / comments

• Add media

  Media

• Assessment of standard 4:

  Met

  Part met

  Not met

5. Work equipment and machinery

• Is correct machinery and equipment provided to the appropriate standards?

• Evidence / comments

• Add media

  Media

• Is equipment adequately maintained?

• Evidence / comments

• Add media

  Media

• Are guards and control measures in place as determined through risk assessment?

• Evidence / comments

• Add media

  Media

• Are safe electrical system and equipment provided and maintained?

• Evidence / comments

• Add media

  Media

• Assessment of standard 5:

  Met

  Part met

  Not met

6. Personal protective equipment and clothing

• Is PPE/C provided, free of charge, to employees as determined through risk assessment?

• Evidence / comments

• Add media

  Media

• Is training and information on the safe use of PPE/C provided to all employees?

• Evidence / comments

• Add media

  Media

• Is the proper use and storage of PPE/C enforced?

• Evidence / comments

• Add media

  Media

• Is PPE/C maintained and replaced?

• Evidence / comments

• Add media

  Media

• Assessment of standard 6:

  Met

  Part met

  Not met

7. Fie and emergencies

• Is there an means of raising the alarm and fire detection I. Place?

• Evidence / comments

• Add media

  Media

• Are there appropriate means of fighting fire in place?

• Evidence / comments

• Add media

  Media

• Are effective means do escape in place including unobstructed routes and exits?

• Evidence / comments

• Add media

  Media

• Has a fire risk assessment been carried out and recorded for all staff?

• Evidence / comments

• Add media

  Media

• Is fire-fighting equipment, preventive measures and emergency arrangements maintained, including thorough test and practise drills?

• Evidence / comments

• Add media

  Media

• Is a fire log/record book kept?

• Evidence / comments

• Add media

  Media

• Assessment of standard 7:

  Met

  Part met

  Not met

8. Safe and healthy working environment

• Are premises (structure, fabric, fixtures and fittings) safe and heathy (suitable, maintained and kept clean)?

• Evidence / comments

• Add media

  Media

• Is the working environment (temperature, lighting, space, ventilation. noise) an appropriate safe and healthy one?

• Evidence / comments

• Add media

  Media

• Are welfare facilities ( toilets, washing, drinking, eating changing) provided as appropriate and maintained?

• Evidence / comments

• Add media

  Media

• If the premises in which the learner is based was built prior to 2000, has an asbestos survey been carried out?

• Evidence / comments

• Add media

  Media

• How is exposure to hazards from physical, chemical and biological agents adequately controlled?

• Evidence / comments

• Add media

  Media

• Assessment of standard 8:

  Met

  Part met

  Not met

General health and safety management

• How does the employer consult and communicate with employees and allow them to participate in health and safety?

• Evidence / comments

• Add media

  Media

• Does the employer provide medical / Heath screening as appropriate and any required medical / health surveillance?

• Evidence / comments

• Add media

  Media

• Does the employer have access to competent health and safety advice and assistance?

• Evidence / comments

• Add media

  Media

• Does the employer undertake reviews of health and safety policies, procedures, etc. at a minimum annual frequency?

• Evidence / comments

• Add media

  Media

• Does the employer display the necessary signs and notices?

• Evidence / comments

• Add media

  Media

• Who is your enforcing authority?
  I.e. HSE, local authority, EHO

• Evidence / comments

• Add media

  Media

• Is the employers liability insurance current and other business insurance in place as appropriate to the business undertaken?

• Evidence / comments Insurer's Name: Policy No. Expiry date: Insurer informed of learners?

• Add media

  Media

• How does the employer assess, review and update employees' capabilities?

• Evidence / comments

• Add media

  Media

• How does the employer manage employees' work when it is away from the employer's own premises or when employees are placed with another employer / site?

• Evidence / comments

• Add media

  Media

• Assessment of standard 9:

  Met

  Part met

  Not met