NORTH COAST MULTI TRADE- PRE-WORK INSPECTION / PRE START RISK ASSESSMENT FORM

• ADDRESS
  Address

• DATE AND TIME

  Date

• DH#

• SUB-CONTRACTOR

• JOB DESCRIPTION

IDENTIFY HAZARDS AND IMPLEMENT CONTROL MEASURES BEFORE COMMENCING WORK

• CHEMICAL

  Safe

  At Risk

  N/A

• TOOLS

  Safe

  At Risk

  N/A

• PEDESTRIANS

  Safe

  At Risk

  N/A

• VEHICLES

  Safe

  At Risk

  N/A

• ELECTRICAL

  Safe

  At Risk

  N/A

• HAZARDOUS SUBSTANCES

  Safe

  At Risk

  N/A

• OVERHEAD SERVICES

  Safe

  At Risk

  N/A

• WEIGHT

  Safe

  At Risk

  N/A

• DEPTH

  Safe

  At Risk

  N/A

• PRESSURE

  Safe

  At Risk

  N/A

• ACCESS

  Safe

  At Risk

  N/A

• HEIGHT

  Safe

  At Risk

  N/A

• SHARPS

  Safe

  At Risk

  N/A

• GASES

  Safe

  At Risk

  N/A

• NOISE

  Safe

  At Risk

  N/A

• WEATHER

  Safe

  At Risk

  N/A

• VIBRATION

  Safe

  At Risk

  N/A

• DUST/FUMES

  Safe

  At Risk

  N/A

• BACTERIA

  Safe

  At Risk

  N/A

• EXCAVATIONS

  Safe

  At Risk

  N/A

• WELDING

  Safe

  At Risk

  N/A

• HOT/COLD OBJECTS

  Safe

  At Risk

  N/A

• LEAD PAINT REMOVAL

  Safe

  At Risk

  N/A

• MOVING EQUIPMENT

  Safe

  At Risk

  N/A

• EXTERNAL HIRE

  Safe

  At Risk

  N/A

• UNDERGROUND SERVICES

  Safe

  At Risk

  N/A

• LIFTING EQUIPMENT

  Safe

  At Risk

  N/A

• ASBESTOS REMOVAL

  Safe

  At Risk

  N/A

• DEHYDRATION

  Safe

  At Risk

  N/A

• RADIATION (SUN)

  Safe

  At Risk

  N/A

• MANUAL HANDLING

  Safe

  At Risk

  N/A

• OVERHEAD

  Safe

  At Risk

  N/A

• CONFINED SPACE

  Safe

  At Risk

  N/A

• HOT WORK

  Safe

  At Risk

  N/A

RATE THE HAZARDS

• RATE THE HAZARDS THAT YOU HAVE IDENTIFIED FOR THEIR POTENTIAL:
  
  -TO KILL. 1. -SERIOUS INJURY. 2. -MEDICAL ATTENTION. 3. - FIRST AID. 4
  
  IF YOU IDENTIFY ANY HAZARDS THAT YOU RATE AS 1 YOU SHOULD NOT PROCEED WITH THE JOB.
  CONTACT MULTI TRADE IMMEDIATELY!
  
  
  

• FIRST HAZARD IDENTIFIED

• RATE THE HAZARD

  TO KILL

  SERIOUS INJURY

  MEDICAL ATTENTION

  FIRST AID

• WHAT ACTION HAVE YOU TAKEN TO CONTROL THE HAZARD?

• SECOND HAZARD IDENTIFIED

• RATE THE HAZARD

  TO KILL

  SERIOUS INJURY

  MEDICAL ATTENTION

  FIRST AID

• WHAT ACTION HAVE YOU TAKEN TO CONTROL THE HAZARD?

• THIRD HAZARD IDENTIFIED

• RATE THE HAZARD

  TO KILL

  SERIOUS INJURY

  MEDICAL ATTENTION

  FIRST AID

• WHAT ACTION HAVE YOU TAKEN TO CONTROL THE HAZARD?

SIGN OFF- ALL CREW MEMBERS ARE AWARE OF HAZARDS AND CONTROLS

• STAFF MEMBER 1

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  Sign

• TS ID CARD

• STAFF MEMBER 2

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  Sign

• TS ID CARD

• STAFF MEMBER 3

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  Sign

• TS ID CARD