Information

PLEASE COMPLETE THIS SECTION IN BLOCK CAPITALS - DOUBLE TAP ON SHIFT KEY MAKES BLOCK CAPS

  • JOB TITLE e.g. SITE NAME - EQUIPMENT / LIFT / BUILDING NAME - JOB 9999

  • SITE NAME

  • ENGINEER

  • Conducted on

  • Location

JOB REFERENCE / DESCRIPTION

USEFUL SITE / LIFT INFORMATION

  • E. G. DOOR CODES / AUTODIALLERS / CONTACT INFO / OTHER USEFUL INFO...

  • PLEASE TAKE ANY USEFUL REFERENCE PHOTOS FOR IDENTIFICATION / USEFUL NUMBERS etc

GROUPS OF PERSONS AT RISK

JOB LOCATION

FREQUENCY AND DURATION OF ACTIVITY

ADDITIONAL SPECIFIC HAZARDS IDENTIFIED

ADDITIONAL CONTROL METHODS REQUIRED

ASSESSMENT OF REMAINING RISKS

EMERGENCY ARRANGEMENTS

TAKE PHOTOS IF NEEDED

  • Take Photos if required.

SIGNATURE

  • Site Specific Assessment Completed by:

  • DATE RISK ASSESSMENT COMPLETED

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