Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Take Photo On Arrival

  • From Outside & Inside

Take 5 - (Write In Notes How You Will Control Any Potential Hazards).

  • Are you Fit for Work?

  • Are you clear on what your task is? (If No, please write an action for what is required)

  • Do you know the company’s health & safety rules? (If No, please write an action for what is required)

  • Are there emergency facilities/an evacuation procedure/route for this site? (N/A if not on construction sites)

  • Do you have access to appropriate emergency and first aid equipment? (If No, please write an action for what is required)

  • Do you have the correct procedures and equipment to do the work safely? (If No, please write an action for what is required)

  • Is all required electrical/mechanical equipment in a safe condition? (If No, please write an action for what is required)

  • Have you consulted with workers about the task and the safe way to do it? (N/A if working on your own)

  • Have you got a safe way of getting in and out of your work area? (If NO, please write in notes how you are going to control this)

  • Have any manual handling risks been identified? (If YES, please write in notes how you are going to control this)

  • Do I have to isolate prior to work commencing? (If YES, please write in notes how you are going to control this)

  • Could this task cause damage/injury to other in work area? (If YES, please write in notes how you are going to control this)

  • Is the work area neat & tidy (clear access)? (If NO, please write in notes how you are going to control this)

  • Can I slip trip or fall? (If YES, please write in notes how you are going to control this)

  • Can I strain or over-exert myself? (If YES, please write in notes how you are going to control this)

  • Can I be caught in, on or between something? (If YES, please write in notes how you are going to control this)

  • Have I look close, wide, high and low around work area? (If NON-COMPLIANT, please write in notes & take photo/s how you are going to control this)

  • Do I need help to do this task?(If YES, please write in notes & take photos)

  • Can something fall on/strike myself or others? (If YES, please write in notes how you are going to control this)

  • Could current weather/environment affect this task? (If YES, please write in notes how you are going to control this)

  • Do you have all necessary PPE? (If No, please write an action for what is required)

  • Is there another hazards: (list below)(If any, please take photo/s & write in notes how you are going to control this)

Final Inspection

  • Explain to customer, how to use door & motor. Warranty paperwork & servicing requirements (yearly servicing)

  • Give customer magnets

  • Are all tools put back in vehicle correctly

  • Is work area left in a clean state - Photo

  • Trailers attached to vehicles correctly

  • All lift equipment in good working order - if NO explain & photos

  • Door/gate in working order - Photo

  • Any damage on door/gate - if so take photos of damage (photo of whole door inside, outside & close ups)

  • Motor operating correctly - Photo (need barcode, make & model)

  • Take photos of brackets, tracks & other hardware fixings

  • Any damage to motor - Take Photos

  • Any other damages to report? if YES explain & photos

  • Is any stock required? (Screw, Bolts, Nuts, Washers & Etc.)

Take Photo On Departure

  • Photo of doors/gates after job and pack up completed.

  • All workers onsite

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.