Title Page

  • 001 Plat4M

  • Plat4M Site Safety Assessment

  • Client

  • Client (select from drop down list)

  • Conducted on

  • Prepared by (record name here)

  • Location

Scope of works

  • Please state the scope of works being done?

Hazard safety assessment

  • Please identify the potential hazards on your worksite in this section

  • Dog(s) on property

  • Check properties before entering for signs of dogs I.e. Posted gate signage, chewed items, kennels, and animal waste. Call owner(s) and ask them to secure dog(s) prior to arrival avoid letting dogs get behind you if present (prominent bite area) be aware of dog(s) body language.

  • Cluttered properties and rubbish

  • Ensure you have adequate footwear and suitable clothing, choose a path that is generally safe for access, discuss meeting the owner at property boundary if possible.

  • Steep ground or uneven ground

  • Ensure you are wearing adequate suitable footwear (safety footwear if required for the location) with adequate ankle support. Maintain sure footing, assess access as you go to avoid potential slips and trips.

  • Weather

  • Dress appropriately for the weather I.e rainwear etc.

  • Visibility

  • Ensure you are wearing high visibility garments I.e. Vest or rainwear.

  • Poor light

  • Ensure you have suitable reflective clothing or artificial lighting

  • Traffic or roadside activities

  • Ensure adequate traffic management in place and safe pedestrian thoroughfare is maintained

  • Parking

  • Vehicles must be parked safely to allow unrestricted traffic movement and you to have safe access to the vehicle out of the traffic flow.

  • Property owners

  • Ensure you have notified property owners of your presence and coming to see them, maintain safe access and retreat if required, avoid engaging in any possible disputes with property owner(s).

  • Please record any other hazards you have identified not already indicated in this section. (Click the "add" button to add a new hazard.

  • hazard noted
  • Record the hazard/risk you have identified here (I.e. What could cause injury or harm in this job)

  • What will you do to manage this hard / risk? (I.e. What will you do to prevent harm or injury?)

  • Are you working alone?

  • Please ensure that all members of your group have read and agreed to the controls identified. They should sign this section and type their names in acknowledgement.

  • Add name and signature of each person here.

  • name and signature
  • Name and signature

  • Have you informed a manager or team member of your location and activity

  • You must notify someone on your team immediately before starting the job. You should include details, location, activity, and ETA.

  • Please record the name of the person you have notified


  • Remember to report any near misses, new hazards, or incidents of injury or harm here.

  • What type of event are you reporting? (Select from options)

  • Provide a brief description of the event

  • What immediate actions have been taken

  • Remember to report the incident to your manager as soon as reasonably able.


  • Name and signature of person submitting form

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.