Lone Working Log

• Site
  Address

• Check in

  Date

• Site Supervisor or Manager

• Location
  Address

• Lone workers are those who work by themselves without close or direct supervision.
  Regular contact between the lone worker and supervisor - this will be in the form of phoning the office at regular and agreed times during the working day – normally the start of the working day, each break time and the end of the working day. These will be recorded on this form along with the person who has taken the call. If contact with the office is not made within agreed check-in times, the office will make contact with the lone worker – either by phone or site visit.

• Record of Contact:

• 1. Start of day

  Date

• Confirm that operative has been spoken to and all okay

  Yes

  No

• Detail follow-up action

• Signed

  Sign

• 2. Tea Break

  Date

• Confirm that operative has been spoken to and all okay

  Yes

  No

• Detail follow-up action

• Signed

  Sign

• 3. Lunch Break

  Date

• Confirm that operative has been spoken to and all okay

  Yes

  No

• Detail follow-up action

• Signed

  Sign

• 4. End of day

  Date

• Confirm that operative has been spoken to and all okay

  Yes

  No

• Detail follow-up action

• Signed

  Sign

Site Supervisor Sign-off

• Add signature

  Sign