Lone Working Risk Assessment Template

• Client / Site

• Department

• Location
  Address

• Conducted on

  Date

• 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?

  No

  Yes

• 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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Location & Premises

• Building security:<br>Is the building secure?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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)?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Process/Work Activity

• Select hazards identified in the work premises

  Select Use of electrical equipment Slip/trips/falls Use of chemicals Use of heavy machinery Manual handling Others

  • Use of electrical equipment
  • Slip/trips/falls
  • Use of chemicals
  • Use of heavy machinery
  • Manual handling
  • Others

• Please specify hazards

• Control/Preventive Measures

• Documentation

  Media

Completion

• Full Name and Signature of Inspector

  Sign