Information
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Conducted on
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Prepared by
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Location
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Please fill out all answers and sign then send to administration
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Am I correctly trained or supervised for this task?
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Do I have the correct tools for this task?
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Are my tools in good condition?
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Have I check and eliminated the risk of objects falling from heights?
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Have I checked and eliminated the risk of slips and trips in the area?
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Do I have the right PPE for the task?
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If using a scissor lift, EWP or forklift do you have the appropriate license?
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Have I confirmed I am not working live?
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Am I using appropriate Lock Out Tag Out equipment for isolations
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Have you checked and / or eliminated the risk of Asbestos, Dangerous goods or other chemical risks in the area?
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Am I/we working at a height of less than 3 meters?
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Is the pitch of the roof less than 30 degrees
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Do you have a harness and is it in good condition?
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Are you aware of any existing Damage/Problems for which we are not responsible ?<br>For example - chipped walls in the work area, cracks in the ceiling where we are working
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Please take Photo's of the affected area?
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Have I communicated any hazards (if any) to my employer?
Signatures
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All personnel working must sign
Person
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Please sign off
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PLEASE ENSURE THAT THIS IS SENT TO THE ADMINISTRATION IMMEDIATELY UPON COMPLETION
