Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Daily Work Summary
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What type(s) of work are being performed today? Select all that apply.
- Scaffolding erection
- Scaffolding dismantle
- Scaffolding alternation
- Handrails
- Framework
- Design work
- OTHER
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What do you expect to achieve by the end of the day?
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Any issues or concerns?
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Is this scaffolding designed / TG20?
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If designed, what is the design number?
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DELIVERIES / COLLECTIONS -
Today's Task Breakdown
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Break today's work into individual step-by-step-tasks below. Assess each task for hazards and controls
Work Task
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Describe this task
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What category does this task fall under?
- Scaffolding erection
- Scaffolding dismantle
- Scaffolding alternation
- Handrails
- Framework
- Design work
- OTHER
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Select potential hazards that may be encountered while completing this task today.
- Uncontrolled Collapse
- Falling / Flying Material / Debris
- Working at Height
- Risk of Fire
- Slips / Trips
- Asbestos Exposure
- Noise / Dust / Vibration Exposure
- Services
- COSHH - Hazardous Substances
- Lifting Operations / use of Lifting Equipment
- Lone Working
- Public Nuisance
- Environmental Impact
- Manual Handling
- Lack of Training and Competence
- Rotating Machinery
- Entry & Exit Hazards
- Ground levels / voids
- Pigeon Guano
- Weils Disease / Leptospirosis
- High Voltage
- Confined Space
- Adverse Weather Conditions
- Pollution
- Hazards to Public Areas
- Extreme Temperature
- Noise
- Social / Interpersonal
- Staffing Issues
- Project Delay
- OTHER
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Describe the other potential hazards that may be encountered while completing this task today.
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What categories of hazard control will you apply to this task?
- Elimination / Substitution - Remove or replace the hazard
- Reduce - the severity hazard or risk / likelihood of harm
- Isolate task / area /people from the hazard
- Information, Instruction, Training
- PPE - Protect workers with personal protective equipment
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What specific controls will you apply to the above hazards for this task?
- Training provided / use of trained operative
- Repair / Replacement/ Maintenance of Plant and Equipment
- Establish physical exclusion zone
- Appoint Banksmen
- Appoint Fire Watchman
- Task Lighting
- Disconnection / Isolation
- Respiratory Protection
- Application of PPE
- Signage
- Use of Permit to Work
- Harness / Fall Arrest
- Extinguishers or fire fighting equipment
- Screens / Debris Netting
- Water Suppressant
- Noise or Vibration Monitoring
- Relevant RAMS In Place
- Machine Certificates available / Pre- use Checks
- CAT Scan / Locating Equipment
- UV Protection
- Gas Detection / Monitoring
- Designated Work Areas
- Specific Supervision of Task
- Elevation to Senior Management
- OTHER
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Describe any other specific controls will you apply to the above hazards for this task.
Final Checks
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Does every member of the on-duty crew have adequate and appropriate PPE for today's work tasks?
Crew Sign Off
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Each present team member to sign name and signature acknowledging the above tasks, hazards and controls.
Team Member
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Name & Signature