PM 010- RISK ASSESSMENT

• PPM / Job No

• DATE

  Date

PROJECT DETAILS

• SITE NAME (Inc Depot Code)

• ADDRESS
  Address

• LOCATION ON SITE

• START DATE & TIME

  Date

• DESCRIPTION OF WORKS TO BE CARRIED OUT

  Select QUARTERLY VISIT FIXED WIRE TEST EMERGENCY LIGHT TEST FIRE EXTINGUISHER SERVICE PAT TESTING WATER TESTING OTHER

  • QUARTERLY VISIT
  • FIXED WIRE TEST
  • EMERGENCY LIGHT TEST
  • FIRE EXTINGUISHER SERVICE
  • PAT TESTING
  • WATER TESTING
  • OTHER

• DESCRIPTION OF WORKS TO BE CARRIED OUT OTHER/ADDITIONAL INFORMATION

• INTERNAL VISUAL INSPECTION TO DETERMINE CONDITION OF GENERAL BUILDING FABRIC

• INTERNAL VISUAL INSPECTION TO DETERMINE CONDITION OF GENERAL BUILDING FIXTURES & FITTINGS

• EXTERNAL VISUAL INSPECTION OF ALL SIGNAGE LIGHTING, YARD LIGHTING & TIMERS

• EXTERNAL VISUAL INSPECTION, INC CONDITION OF DOWNPIPES, DRAINS & CHANNELS

• REPAIR & MAINTENANCE OF BUILDING FABRIC EG. MINOR PLASTERING, JOINERY, PLUMBING, PAINTING & IRONMONGERY

• REPAIR & MAINTENANCE OF BUILDING FIXTURES EG. FITTING NOTICE BOARDS, SHELVING, ETC

• ROOF ACCESS TO INSPECT, CLEAN & CLEAR ALL ROOF DRAINAGE CHANNELS & OUTLETS WHERE SAFE TO DO SO

• SERVICE OF FIRE ALARM SYSTEM AND/OR COMPONENT PART REPLACEMENT

• SERVICE & MAINTENANCE OF FIRE EXTINGUISHERS

• IDENTIFY & REPLACE ALL NON OPERATIONAL LAMPS AT LOW LEVEL WITHOUT STEPS

• IDENTIFY & REPLACE ALL NON OPERATIONAL LAMPS AT LOW LEVEL WITH STEPS

• IDENTIFY & REPLACE ALL NON OPERATIONAL LAMPS AT LOW/HIGH LEVEL WITH SPECIFIC ACCESS EQUIPMENT

• IDENTIFY, REMOVE & MAINTAIN LANDSCAPES AT LOW/HIGH LEVEL WITH SPECIFIC ACCESS EQUIPMENT

• OTHER

• Please specify other

ISOLATION OF ELECTRICAL SUPPLIES

• EQUIPMENT TO BE ISOLATED

• MEANS OF ISOLATION

• WARNING NOTICES POSTED AT

• CIRCUIT ISOLATED AT & REF NO.

• APPROX DURATION OF ISOLATION

• Add signature

  Sign

• INCLUDE PICTURE OF SAFE ISOLATION

  Media

WORK EQUIPMENT REQUIRED FOR TASK

• STEPLADDERS

  YES

  NO

  N/A

• LADDERS

  YES

  NO

  N/A

• MULTIMETER / TEST INSTRUMENTS

  YES

  NO

  N/A

• 110v POWER TOOLS

  YES

  NO

  N/A

• 110v TRANSFORMER

  YES

  NO

  N/A

• HAND TOOLS

  YES

  NO

  N/A

• FIRE TEST EQUIPMENT

  YES

  NO

  N/A

• CORDLESS TOOLS

  YES

  NO

  N/A

• LANDSCAPING TOOLS

  YES

  NO

  N/A

• OTHER

  YES

  NO

  N/A

• Specify Other

GENERIC RA & GUIDANCE

• 01 WORKING IN OCCUPIED PREMISES

  YES

  NO

  N/A

• 02 LONE WORKING

  YES

  NO

  N/A

• 03 MANUAL HANDLING

  YES

  NO

  N/A

• 04 USE OF PORTABLE POWER TOOLS

  YES

  NO

  N/A

• 05 SAFE USE OF STEPLADDERS

  YES

  NO

  N/A

• 06 SAFE USE OF PODIUM STEPS

  YES

  NO

  N/A

• 07 SAFE USE OF LADDERS

  YES

  NO

  N/A

• 08 ROOF ACCESS & WORKS

  YES

  NO

  N/A

• 09 REMOVING & INSTALLING LUMINARIES

  YES

  NO

  N/A

• 10 CHANGING & CLEANING A/C FILTERS

  YES

  NO

  N/A

• 11 GENERAL PLUMBING

  YES

  NO

  N/A

• 12 GENERAL PAINTING

  YES

  NO

  N/A

• 13 ELECTRICAL WORKS WITHIN EXISTING DISTRIBUTION BOARDS

  YES

  NO

  N/A

• 14 WORKING ON OR NEAR LOW VOLTAGE ELECTRICAL SYSTEMS

  YES

  NO

  N/A

• 15 ELECTRICAL DEAD WORKING PROCEDURE

  YES

  NO

  N/A

• 16 FIRE ALARM PANEL MAINTENANCE

  YES

  NO

  N/A

• 17 PORTABLE APPLIANCE TESTING

  YES

  NO

  N/A

• 18 MOBILE TOWER SCAFFOLDS

  YES

  NO

  N/A

• 19 MEWPS & ASSOCIATED RESCUE PLANS

  YES

  NO

  N/A

• 20 LANDSCAPING USING POWERED TOOLS

  YES

  NO

  N/A

• 21 LANDSCAPING USING HEDGE TRIMMER

  YES

  NO

  N/A

• 22 HAND ARM VIBRATION

  YES

  NO

  N/A

PPE CHECK

• HARD HAT

• SAFETY FOOTWEAR

• HI VIZ

• GLOVES

• EYE PROTECTION

• EAR PROTECTION

• OTHER

• Specify Other

JOB SPECIFIC ASSESSMENT

• HAZARDS

  Select GENERAL WORKING SLIPS, TRIPS & FALLS MOBILE PHONES MOVING VEHICLES HAND TOOLS

  • GENERAL WORKING
  • SLIPS, TRIPS & FALLS
  • MOBILE PHONES
  • MOVING VEHICLES
  • HAND TOOLS

• CONTROL MEASURES

  Select CONTROLLED THROUGH CITY SMS TRAINED OPRATIVES PPE AIRPLANE MODE / MANAGERS AUTHORIZATION

  • CONTROLLED THROUGH CITY SMS
  • TRAINED OPRATIVES
  • PPE
  • AIRPLANE MODE / MANAGERS AUTHORIZATION

• Other Infomation

SITE INDUCTION

• DO YOU KNOW THE EMERGENCY PROCEDURES FOR THE SITE, INC THE FIRE EVACUATION ARRANGEMENTS, FIRST AID ARRANGEMENTS AND WHERE TO REPORT ACCIDENTS

  YES

  NO

  N/A

• HAVE YOU GOT SAFE ACCESS TO THE WORKPLACE, ADEQUATE LIGHTING, AND ARE YOU PROTECTED FROM MOVING PARTS OF CLIENTS MACHINERY OR FROM BEING STRUCK VEHICLES

  YES

  NO

  N/A

• HAVE THE WORK AREAS AND ACCESS ROUTES BEEN ASSESSED AND APPROPRIATE MEANS OF SEGREGATION PUT IN PLACE

  YES

  NO

  N/A

• DOES THE CURRENT RISK CONTROL MEASURES STATED IN THE RA's ADEQUATELY CONTROL THE HAZARDS FACED ON SITE

  YES

  NO

  N/A

• HAVE YOU CONSULTED THE STORE ASBESTOS REGISTER AND ESTABLISHED THAT YOU WILL NOT DISTURB ANY ACM's

  YES

  NO

  N/A

DECLARATIONS

• SITE PERSONNEL AUTHORISATION - I CONFIRM I HAVE READ AND UNDERSTOOD THE CONSTRAINTS IMPOSED BY THE RISK ASSESSMENTS AND THE PRECAUTIONS IDENTIFIED ABOVE AND WILL ENSURE THAT THE ABOVE WORK IS CARRIED OUT IN ACCORDANCE WITH THEM.

• SITE PERSONNEL AUTHORISATION

  Sign

• DATE & TIME

  Date

• CUSTOMER'S REPRESENTATIVE DECLARATION - I CONFIRM THAT I HAVE INFORMED THE CONTRACTOR OF THE SITE EMERGENCY PROCEDURES AND OTHER HAZARDS OUTSIDE THEIR CONTROL.

• CUSTOMER'S REPRESENTATIVE DECLARATION

  Sign

• DATE & TIME

  Date

COMPLETION OF WORKS

• IS THE WORK AREA CLEAN & TIDY

  YES

  NO

  N/A

• IS POWER REINSTATED, RCD's RESET, COVERS REPLACED

  YES

  NO

  N/A

• IS THE COMPLIANCE FOLDER UP TO DATE

  YES

  NO

  N/A

CUSTOMERS REPRESENTATIVE SIGN OFF

• I CONFIRM THE WORKS HAVE BEEN COMPLETED TO MY SATISFACTION AND THE WORK AREAS HAVE BEEN LEFT SAFE & TIDY.

• SIGNATURE

  Sign

• DATE & TIME

  Date

COMPLETION PHOTO

• Photo's

  Media