Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Names of Site Team

  • Details of Task

Hazards relevant for work

  • Identify all relevant hazards associated with the work

  • State nature of hazard

Control Measures - identify type of work and relevant controls from the list

  • Does the work involve site set up

  • Identify relevant controls

  • Add any additional controls you are undertaking

  • Does the work involve excavation and need to locate buried services

  • Identify relevant controls

  • Add any additional controls you are undertaking

  • Are you using of Plant or Power tools (environmental controls should be covered in Environmental section)

  • Identify relevant controls

  • Add any additional controls you are undertaking

  • Does the work involve Manual handling activities

  • Identify relevant controls

  • Add any additional controls you are undertaking

  • Mechanical lifting controls

  • Add any additional controls - photo lift plan etc.

  • Does the work involve Dust Generation Operations

  • Identify relevant controls

  • Add any additional controls you are undertaking

  • Are there additional controls required due to weather conditions / light levels

  • Identify relevant controls

  • Add any additional controls you are undertaking

  • Are you using hazardous substances during the work

  • Identify relevant controls

  • Add any additional controls you are undertaking

  • Identify any relevant environmental controls

  • Add any additional controls you are undertaking

  • General Safety and House-Keeping

  • Add any additional controls you are undertaking

  • Identify any additional controls not previously listed

Sign off Section -POWRA is an important part of any site work and it is essential that everyone is aware of the details of this document and the agreed safe working methods. It is good practice to get everyone involved in POWRA as this ensures engagement and understanding plus can improve quality.

  • All personnel listed on the POWRA understand the hazards and control measures detailed

  • Site Team Member sign to show the have understood POWRA

  • Site Team Member sign to show the have understood POWRA

  • Site Team Member sign to show the have understood POWRA

  • Site Team Member sign to show the have understood POWRA

  • I confirm that the control measures above will be followed and I will ensure everyone site will follow the agreed safe methods of work agreed.

  • Jurassic Fibre Supervisor or SHE Advisor on site and reviewed POWRA

  • Name

  • Comments

  • Contractors Supervisor, Manager or SHE Advisor on site and reviewed POWRA

  • Name

  • Comments

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.