Lone workers involved


Lone worker's name and role


Medical Fitness:
Is the Lone Worker subject to any medical condition that may place them at increased risk when working alone?

Supervision: What arrangements are in place to maintain contact with the lone worker?

Training & Competency :
Has necessary information, instruction, and training been given to the lone worker?

Training & Competency: Is the lone worker competent to carry out the work alone?

Location & Premises

Building security:
Is the building secure?

Is there a safe means of access/egress for the lone worker?

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)?

First aid:
Are there arrangements are in place to deal with a situation where the lone worker becomes ill or has an accident?

Welfare facilities:
Is there adequate heating, lighting, access to drinking water and toilets?

Process/Work Activity
Select hazards identified in the work premises

Please specify hazards

Control/Preventive Measures

Full Name and Signature of Inspector