HS 000_Rev00_At Risk Report and Action Plan_draft

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A

• Yes

  No

  N/A

• The Report and Action Plan is required to be approved by the H&S Dept. prior to recommencing the work activity

  Yes

  No

  N/A

• Contract Manager:

• Project Manager:

• Project:

• Client:

Who was involved in the incident?

• Supervisor/Operatives/Sub-contractor etc

• When did it take place?

• Time/Date/Location/Weather

  Date

Where was the issue identified?

• Location: Block/Level/Elevation etc

What happened?

• Description/outcome/potential outcome

Why did it happen?

• Issues leading up to it/Supervision/ competencies etc

  Yes

  No

  N/A

How are you going to prevent a reoccurrence?

• Preventative Actions

  Yes

  No

  N/A

Have the relevant RAMS been reviewed, updated and re-briefed?

• Record updates

  Yes

  No

  N/A

• This Issue has been identified as:

• LEVEL

  Yes

  No

  N/A

• LEVEL 1

  Yes

  No

  N/A

(Reoccurring Non-Compliance: Housekeeping; Environmental; Documentation; 1st Aid)

• Off Site Close Out by H&S Dept. Approved by H&S Manager

  Yes

  No

  N/A

• LEVEL 2

  Yes

  No

  N/A

(Ladders; Haki/Peri-up; Lighting/Tools/Equipment; PPE; CoSHH; Fire; Access/Egress)

• On Site Close Out by H&S Dept. Approved by H&S Manager

  Yes

  No

  N/A

• LEVEL 3

  Yes

  No

  N/A

(W@H; Excavations; Stairs/Lift Voids; Floor Void; Lifting Operations; Temporary Works; Plant/Machinery)

• On Site Close Out by H&S Dept. Approved by Director

  Yes

  No

  N/A