Title Page

  • Site conducted

  • Document number

  • Conducted on

  • Prepared by

  • Location
  • Date work commences

  • Date work finishes

  • Task being assessed

  • Names of people carrying out the work

  • Total number of workers

Who might be affected

  • Types of People

Risk Assessment

    Hazard, Risks and Controls
  • What is the hazard?

  • What are the control measures?

  • What is the likelihood?

  • What are the consequences?

  • What is the risk level?

  • Is the risk level acceptable?

  • Specify the extra control measures required to ensure the risk level becomes acceptable.

References

  • Risk Matrix Reference

    4x4 risk matrix.jpg
  • Hierarchy of Controls Reference

Method Statement

Training

  • Specify the training

Tools and Equipment

  • undefined

PPE

  • Requirements

First Aid

  • Requirements

Emergency Procedures

  • Requirements

Welfare Requirements

  • Requirements

Environmental and Waste Management

  • Requirements

  • Do you need a Permit to Work?

  • Specify the PTW required

Procedure Before Work Commences

  • What do you need to do ?

Procedures During the Work

  • How are you going to do the work?

Procedure at the End of Works

  • What do you need to do?

Completion

  • Are there any other issues that might need to addressed in future

  • Specify

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.