infrastruct Contracting Job Risk Assessment for line Work

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

• Job Reference Number

  Yes

  No

  N/A

• Where is the Muster Point in case of Emergency?

  Yes

  No

  N/A

Job Planning Risk Assessment (refer to the Hazard Risk Assessment Guide)

• Entered By

  Select Graham Purua Raymond Whale James Van Trijp Sam Rangi Andrew Bailey

  • Graham Purua
  • Raymond Whale
  • James Van Trijp
  • Sam Rangi
  • Andrew Bailey

• Select date

  Date

• Hazards Identified

  Yes

  No

  N/A

• Risk Level

  Select Very High High Medium Low Very Low

  • Very High
  • High
  • Medium
  • Low
  • Very Low

• Control Measures Required

  Yes

  No

  N/A

• Action By

  Select Graham Purua Raymond Whale James Van Trijp Sam Rangi Andrew Bailey

  • Graham Purua
  • Raymond Whale
  • James Van Trijp
  • Sam Rangi
  • Andrew Bailey

• Select date

  Date

• Hazards Identified

  Yes

  No

  N/A

• Risk Level

  Select Very High High Medium Low Very Low

  • Very High
  • High
  • Medium
  • Low
  • Very Low

• Control Measures Required

  Yes

  No

  N/A

• Action By

  Select Graham Purua Raymond Whale James Van Trijp Sam Rangi Andrew Bailey

  • Graham Purua
  • Raymond Whale
  • James Van Trijp
  • Sam Rangi
  • Andrew Bailey

• Select date

  Date

• Hazards Identified

  Yes

  No

  N/A

• Risk Level

  Select Very High High Medium Low Very Low

  • Very High
  • High
  • Medium
  • Low
  • Very Low

• Control Measures Required

  Yes

  No

  N/A

• Action By

  Select Graham Purua Raymond Whale James Van Trijp Sam Rangi Andrew Bailey

  • Graham Purua
  • Raymond Whale
  • James Van Trijp
  • Sam Rangi
  • Andrew Bailey

• Prior to commencing the job all team members/ contractors MUST conduct a Job Risk Assessment at the worksite, which remains valid for one shift only

Team Worksite Risk Assessment (refer to Hazard and Risk Assessment Guide)

• Job Leader

  Select Graham Purua Raymond Whale James Van Trijp Sam Rangi Andrew Bailey

  • Graham Purua
  • Raymond Whale
  • James Van Trijp
  • Sam Rangi
  • Andrew Bailey

• Select date

  Date

• Specific Work Hazards Identified

  Yes

  No

  N/A

• Risk Level

  Select Very High High Medium Low Very Low

  • Very High
  • High
  • Medium
  • Low
  • Very Low

• Control Measures Used

  Safe

  At Risk

  N/A

• Action By

  Select Graham Purua Raymond Whale James Van Trijp Sam Rangi Andrew Bailey

  • Graham Purua
  • Raymond Whale
  • James Van Trijp
  • Sam Rangi
  • Andrew Bailey

• Specific Work Hazards Identified

  Yes

  No

  N/A

• Risk Level

  Select Very High High Medium Low Very Low

  • Very High
  • High
  • Medium
  • Low
  • Very Low

• Control Measures Used

  Safe

  At Risk

  N/A

• Action By

  Select Graham Purua Raymond Whale James Van Trijp Sam Rangi Andrew Bailey

  • Graham Purua
  • Raymond Whale
  • James Van Trijp
  • Sam Rangi
  • Andrew Bailey

• I have participated in this Job Risk Assessment and have been made aware of the identified hazards and agree with the control measures documented

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• When hazards are identified while carrying out a job, all team members/contractors must stop work IMMEDIATELY. All team members must then discuss,access,agree and document the control measures to be implemented.

Job Review

• Were there any hazards/incidents identified that require follow up?

  Yes

  No

• Were there any "Near Hits"?

  Yes

  No

• Was anyone injured?

  Yes

  No

• Was there any damage to property,plant or environment?

  Yes

  No

• If you answered YES to any of the Job Review questions in the above section fill out a Hazard/ incident Report within 4 hours and forward it to your formal leader.

• Hazard/Incident Report Completed by

  Select Graham Purua Raymond Whale James Van Trijp Sam Rangi Andrew Bailey

  • Graham Purua
  • Raymond Whale
  • James Van Trijp
  • Sam Rangi
  • Andrew Bailey

• Select date

  Date

Completion/Sign Off

• I have checked that all sections of this form have bee adequately completed and verify by signing below.

  Sign