Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Before you start
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Are you at the correct site, item of plant or location?
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Do you have the right documentation for the job?
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Do you have the right PPE for the job?
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Are power tools, leads and equipment in good condition and tested?
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Is working at height equipment in good condition and has been inspected by you before use?
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Is lifting equipment in good order, inspected before use?
HSE Assessment
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Please select those hazards that are identified and could pose a risk to you whilst carrying out this activity. Give a brief description of the hazard and its location. Look and think of hiden risks also.
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Falls from height
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Falling or flying objects
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Chemicals or harmful substances
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Heat, fire or explosion
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Asphyxiation or drowning
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Risk to product
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Contact/collision with stationary/fixed objects
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Equipment overturning or collapsing
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Slips, trips and falls on the same level
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Entry into a confined space
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Dust
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Fumes
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Noise
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Vibration
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Electrical Hazards
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Manual handling
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Poor lighting
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Temperatures (High/Low)
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Adverse Weather
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Stored energy/gravity
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If your are entering a confined space or working at heights, you must have a rescue plan in place. Please provide basic details below.
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Are control measures in place to reduce the risk to yourself and others?
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If NO controls are in place then the task should not proceed. Job "STOP" contact your host/supervisor immediately.
Additional Risk Reduction Measures
- Hazard Identified
Control Measures
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Remaining Risks Assessed
End of Job Review
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Are there any lessons to be learned for the customer sites next visit?
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Has the work introduced any new hazards?
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If you have answered "Yes" to any of the above questions, please add a brief note below and advise your supervisor and sales.
HSE Leasons Learnt at Location
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Leasons learnt for future visits
