Title Page
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Document No.
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Task Name
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Conducted on
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Client / Site
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Prepared by
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Location
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Personnel
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Did you got relevant permits?
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Did you agree with client work that needs be done?
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Did you inspect working area and identified hazards?<br>
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Hazards identified:
- Slips, Trips, Falls
- Injury using hand tools,
- Injury using battery operated tools,
- Manual handling
- Electricity
- Lone working
- Moving vehicle
- Working on height
- Pinch points
- Weather condition
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Additional hazards that hasn't been listed.
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What PPE do you need??
- Hi-Vis Vest
- Safety Glasses
- Hard hat / Bump Hat
- Cut Resistant Gloves
- Safety Harness
- Ear Plugs
- Safety Boots / Shoes
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Did you inspect battery operated tools?<br>
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On what voltage you working?
- 12/24V DC
- 12/24V AC
- 110/230V AC
- 380/400V AC
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Do you need to isolate power?<br>
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Did you inspect MEWP before use?
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Did you inspect safety harness before use?
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Did you inspect ladder before use?
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Clean as you go policy at all time?
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Other information.
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Add signature