Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Take Photo On Arrival
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From Outside & Inside
Take 5 - (Write In Notes How You Will Control Any Potential Hazards).
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Are you Fit for Work?
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Are you clear on what your task is? (If No, please write an action for what is required)
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Do you know the company’s health & safety rules? (If No, please write an action for what is required)
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Are there emergency facilities/an evacuation procedure/route for this site? (N/A if not on construction sites)
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Do you have access to appropriate emergency and first aid equipment? (If No, please write an action for what is required)
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Do you have the correct procedures and equipment to do the work safely? (If No, please write an action for what is required)
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Is all required electrical/mechanical equipment in a safe condition? (If No, please write an action for what is required)
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Have you consulted with workers about the task and the safe way to do it? (N/A if working on your own)
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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)
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Have any manual handling risks been identified? (If YES, please write in notes how you are going to control this)
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Do I have to isolate prior to work commencing? (If YES, please write in notes how you are going to control this)
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Could this task cause damage/injury to other in work area? (If YES, please write in notes how you are going to control this)
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Is the work area neat & tidy (clear access)? (If NO, please write in notes how you are going to control this)
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Can I slip trip or fall? (If YES, please write in notes how you are going to control this)
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Can I strain or over-exert myself? (If YES, please write in notes how you are going to control this)
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Can I be caught in, on or between something? (If YES, please write in notes how you are going to control this)
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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)
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Do I need help to do this task?(If YES, please write in notes & take photos)
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Can something fall on/strike myself or others? (If YES, please write in notes how you are going to control this)
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Could current weather/environment affect this task? (If YES, please write in notes how you are going to control this)
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Do you have all necessary PPE? (If No, please write an action for what is required)
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Is there another hazards: (list below)(If any, please take photo/s & write in notes how you are going to control this)
Final Inspection
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Explain to customer, how to use door & motor. Warranty paperwork & servicing requirements (yearly servicing)
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Give customer magnets
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Are all tools put back in vehicle correctly
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Is work area left in a clean state - Photo
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Trailers attached to vehicles correctly
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All lift equipment in good working order - if NO explain & photos
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Door/gate in working order - Photo
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Any damage on door/gate - if so take photos of damage (photo of whole door inside, outside & close ups)
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Motor operating correctly - Photo (need barcode, make & model)
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Take photos of brackets, tracks & other hardware fixings
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Any damage to motor - Take Photos
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Any other damages to report? if YES explain & photos
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Is any stock required? (Screw, Bolts, Nuts, Washers & Etc.)
Take Photo On Departure
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Photo of doors/gates after job and pack up completed.
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All workers onsite