Title Page
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Client / Site
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Department
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Location
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Conducted on
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Prepared by
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Lone workers involved
Staff
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Lone worker's name and role
Individual
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Medical Fitness:<br>Is the Lone Worker subject to any medical condition that may place them at increased risk when working alone?
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Supervision: What arrangements are in place to maintain contact with the lone worker?
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Training & Competency : <br>Has necessary information, instruction, and training been given to the lone worker?
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Training & Competency: Is the lone worker competent to carry out the work alone?
Location & Premises
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Building security:<br>Is the building secure?
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Access: <br>Is there a safe means of access/egress for the lone worker?
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Emergencies: <br>Does the lone worker have access to emergency warning devices to raise the alarm in event of emergency e.g. fire alarm, motion sensors /manual device (panic alarms)?
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First aid:<br>Are there arrangements are in place to deal with a situation where the lone worker becomes ill or has an accident?
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Welfare facilities: <br>Is there adequate heating, lighting, access to drinking water and toilets?
Process/Work Activity
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Select hazards identified in the work premises
- Use of electrical equipment
- Slip/trips/falls
- Use of chemicals
- Use of heavy machinery
- Manual handling
- Others
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Please specify hazards
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Control/Preventive Measures
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Documentation
Completion
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Full Name and Signature of Inspector