Lone Working Risk Assessment Checklist (Hazard Report)
Lone workers can use this template to report any hazard present during their work shift. Simply do a site walkthrough, capture photos of findings and evidence of any risk that may affect safety, and assign actions to authorized personnel if these hazards would hinder you to continue working. Lastly, provide an overall risk rating.
Scan this QR code to use this paper checklist on your smartphone or tablet or
visit
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Title Page
Name of Lone Worker
Department
Conducted on
Location
Prepared by
General Details
Description of task/s involved
Hazards and Risks
Click + to add hazards identified
Hazard
Identify type of hazard
Description of observed risk
Does this hazard hinder you from finishing your work alone?
Completion
Upon evaluating all hazards before commencing work, rate the overall safety of the workplace
Full Name and Signature of Lone Worker
SafetyCulture Staff
Lone Working Risk Assessment Checklist (Hazard Report)
Lone workers can use this template to report any hazard present during their work shift. Simply do a site walkthrough, capture photos of findings and evidence of any risk that may affect safety, and assign actions to authorized personnel if these hazards would hinder you to continue working. Lastly, provide an overall risk rating.
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions.
The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction.
You should independently determine whether the template is suitable for your circumstances.
