Last Minute Risk Analyses

General

• Cliënt of customer?

• Location?
  Address

• Time?

  Date

01 Work permit!

• On site is there a work permit?

  Yes

  No

  Not Applicable (n.a.)

01.1 Work permit1

• If there is a work permit on site, is it clear?

  Yes

  No

  Not Applicable (n.a.)

02 Risks!

• Are risks from the surrounding known?

  Yes

  No

  Not Applicable (n.a.)

03 Escape route!

• Safe escape route known and accessible?

  Yes

  No

  Not Applicable (n.a.)

04 Workplace!

• Will you fence in the workplace if needed?

  Yes

  No

  Not Applicable (n.a.)

05 Transport!

• Is horizontal and vertical transport safe?

  Yes

  No

  Not Applicable (n.a.)

06 Workplace!

• Is the workplace clear and safe?

  Yes

  No

  Not Applicable (n.a.)

07 Personal Protective Equipment!

• Do you have the correct personal protective means?

  Yes

  No

  Not Applicable (n.a.)

08 Materials and equipment!

• Is the correct material and/or equipment present?

  Yes

  No

  Not Applicable (n.a.)

09 (Engineering) drawing!

• Is the correct drawing present?

  Yes

  No

  Not Applicable (n.a.)

10 Fall hazard!

• Can you work safely without danger of falling?

  Yes

  No

  Not Applicable (n.a.)

11 Work!

• Is it possible to work in a safe way now?

  Yes

  No

  Not Applicable (n.a.)

Persons!

• How many persons were present in totally?

  Select 1 2 3 4 5 6 7 8 9 10 > 10

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • > 10

Names?

• 1 Name

  Sign

• 2 Name

  Sign

• 3 Name

  Sign

• 4 Name

  Sign

• 5 Name

  Sign

• 6 Name

  Sign

• 7 Name

  Sign

• 8 Name

  Sign

• 9 Name

  Sign

• 10 Name

  Sign

Superior!

• Name?

  John Huisman

  Victor Schikhof

• Signature!

  Sign