Title Page

  • undefined

  • Department

  • Location
  • Conducted on

  • Prepared by

  • Lone workers involved

  • Staff
  • Lone worker's name and role

Individual

  • Medical Fitness:<br>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 : <br>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:<br>Is the building secure?

  • Access: <br>Is there a safe means of access/egress for the lone worker?

  • 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)?

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

  • Welfare facilities: <br>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

  • Documentation

Completion

  • Full Name and Signature of Inspector

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