Information

  • Prepared by

  • Date

  • Site Location and Postcode
  • SAFE SYSTEM OF WORK ASSESSMENT

  • Work instructions available

  • Does your work affect others

  • Can other people's work affect you

  • Does everyone have the correct PPE for todays work

  • Is everyone on site trained in the task they are carrying out

  • ENVIRONMENT ASSESSMENT

  • Have all areas of valuable habitat been protected

  • Have you been made aware of sensitive customers

  • Do you have a suitable refuelling point

  • Do you have the correct authority to work (TPO, SSSI)

  • WORKING AT HEIGHT (WAH) ASSESSMENT

  • Work from ground (Low Risk)

  • MEWP Access (Medium Risk)

  • Ropes and Harness access (High Risk)

  • WAH Justification Add why you consider your decision the most appropriate for the task- e.g. All work can be carried out from ground safety/ MEWP access/ etc.

  • Please list generic risk assessments and method statements associated with this task:

  • Site specific risks and hazards - Controls/ actions required/ comments

  • Site Hazards- access/ egress, services, weather conditions, ground conditions, fuel storage, badgers/ birds/ bats, traffic management, needles and sharps, public access.

  • Who and how affected- operatives, general public, other site workers, lone workers.

  • Control measures required and by whom- safe working distance, appropriate training, additional machinery, additional PPE, assisted felling, additional emergency planning.

  • Site specific working methods- How do you intend to carry out this work? Add a description. Include any details of working at height, specialist kit, competence, supervision, banksman, drop zones, exclusion zones, lowering and felling controls.

  • Emergency Procedures and Planning

  • Access route for emergency services:

  • Grid reference:

  • Emergency services meeting point:

  • Nearest A&E hospital:

  • Nominated first aider:

  • Nominated aerial/ pole top/ MEWP rescuers

  • Emergency rescue kit location:

  • Mobile phone signal strength:

  • Nearest working landline:

  • Notes:

  • Nominated Team Leader; I confirm that I have verified this risk assessment and amended where necessary. I have briefed the team of risks, controls, job plan, safe working methods and emergency procedures. I have detailed and rebriefed any amendments made:

  • Team Leader Sign:

  • Team Members; I confirm that I have been briefed and understood and/ or contributed to this site specific risk assessment and will carry out works accordingly taking into consideration the appropriate control measures identified on this document and the associated risk assessments and method statements.

  • Team Members Sign:

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

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