Title Page
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Ticket No.
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Prepared by
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Are any other DH Telecom eemployees assisting in this task?
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Please select the names of all persons present.
- Daniel Hunt
- Joe Burns
- Thomas Sleigh
- Keean Arnold
- Adam Clifton
- Elliot Rushton
- Daniel Dodd
- Martin Dugdale
- David Hartley
- Stuart Cameron
- Steven Hardman
- Keiron Molyneux
- Arran Scott
- Other
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Description of task
- Working in a chamber
- Working in a cabinet
- Fault investigation & rectification
- Customer site installation
- External installation
- Other
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Please write a short description of the works
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Conducted on
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Location
STOP - STEP BACK - THINK
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Do you know what has to be done?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Do you know how to do it?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Do you have safe access?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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If required has a permit to work been completed?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Can the task be done without effecting others significantly putting them at risk?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Is the area clear of equipment or materials around you than can affect you?
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Have suitable and sufficient welfare facilities been made available for all persons on site.
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If location of welfare facilities are not known you must contact your manager immediately prior to commencing works.
STOP - STEP BACK - THINK
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Do you have the correct tools for the job available, in good condition and calibrated if applicable?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Is the correct PPE for the job available and in good condition?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Have you been able to control and excessive noise or hazardous substances which you may be exposed to?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Are the weather conditions acceptable for the works being undertaken? (if you are not sure contact a manager)
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Have you read and understood all relevant documentation in relation to this task (e.g., RAMS)?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Are you making a change that could introduce a new hazard?
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Have the new hazards been considered with suitable and sufficient steps taken to mitigate the risk?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
Identify Hazards
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Please select all hazards which have been considered.
- Slip, Trip
- Fall
- Hand & finger injury
- Eye Injury
- Electric Shock
- Extreme Temperature
- Fixed Plant Movements
- Falling Objects
- Hazardous Substance
- Confined Space
- Working at Heights
- Vehicles / Mobile Plant Movements
- Explosion or Intoxication
- Lone Working
- Manual Handling
- Adverse Weather
- Poor Lighting
- Aggression from the Public
- Fire
- Drugs paraphernalia
- Don't have the correct tools for the job
- Fumes
- Unable to isolate electrically
- Can't locate work site
- Unable to park safely
- Excessive traffic
- Overhead services
- Underground services
- Restricted space / access
- Asbestos
- Third parties n the work site
- Open excavations
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Have any other hazards been identified?
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Please state additional hazards identified.
Eliminate / Mitigate
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Have the hazards been removed?
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Have the hazards been mitigated?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Have the hazards been isolated if necessary?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Have you communicated with team members regarding the identified hazards?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Do all party members understand what must happen in the event of an emergency?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Is emergency equipment available? (e.g. first-aid kit)
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If the answer is no you must contact your manager immediately and the task must NOT commence.
Can this task continue safely?
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Can this task continue safely?
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If the answer is no you must contact your manager immediately and the task must NOT commence.
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Please note any additional comments
Review Section
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All involved parties must sign below to confirm that they are competent in completing the required task and that all necessary safety precautions have been taken.
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Signature of DH Telecom Party Leader
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Signature of other DH Telecom employees present (if applicable)
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Signature of other DH Telecom employees present (if applicable)
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Signature of other DH Telecom employees present (if applicable)
