Information

  • Team

  • Engineer

  • Prepared by

  • Conducted on

  • Location

Risk assessment

  • Hazards identified

  • Parking correctly

  • MFT completed prior to job start

Manual handling

  • Lifting correctly

  • No overloading

  • Ladders carried correctly

  • Drill in box

  • Ladder rack returned

  • Gloves used

  • Comments

Working at height

  • Y-hang

  • Rope tie off

  • Cows tail opposite to dish

  • No overstratching

  • Rope grab and cows tail at highest point

  • Pitched roof work

  • Flat roof work

  • Chimney work

  • Harness tight and not twisted

  • Aware of hierarchy and escalation

  • Comments

Use of required equipment

  • Ladders used

  • Laddermate

  • Microlite

  • Eyebolt

  • Ropegrab

  • Ratchet strap not twisted

  • Rope used

  • Gravel bag

  • Crawl boards

  • Cones

  • Comments

PPE usage

  • Helmet

  • Gloves

  • Goggles

  • Ear plugs

  • Dustmask

  • Kneepads

  • Boots

  • Hi vis

  • Comments

Cabling / clipping

  • Fall arrest used

  • Goggles

  • No over-stretching

  • Old cable removed safely

  • Cable clips correct

  • Cable to low level

  • Cable run suitable

  • Comments

Damage awareness / drilling practices

  • Internal / external checks

  • Ear plugs

  • Goggles

  • Dustmask

  • Holes sealed / brick burst

  • Pipe detector

  • Shoe covers

  • Predictive drilling

  • Dustpan

  • Hammer action off on exit

  • Comments

Safety of customer / 3rd parties

  • Tools left in safe place

  • Safe working area

  • 3rd parties removed

  • Consideration for public

  • Site left clean and tidy

  • Comments

Overall behaviour

  • Overall safe or unsafe?

  • Overall comments

  • Add media

  • Add media

  • Add media

  • Add media

  • Managers signature

  • Engineers signature

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.