Title Page
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Conducted on
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Prepared by
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Why?
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Location
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Has all hang up been removed?
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Why?
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Please Take Photo
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Please take photo
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Is the Deflector clear of all product?
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Why?
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Please Take Photo
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Please take photo
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Has the conveyor, feeder or screen above been run clear of product or hosed back and boarded to prevent engulfment?
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Why?
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Please take photo
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Please take photo
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Is the entrance way clear of hazards and items that could restrict access?
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Why?
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Please take photo
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Please take photo
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Is this confined space safe and ready for work to commence.
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Why?
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Conditions
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Please take photo
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Supervisor Sign off
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Supervisor Sign off