Title Page
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Supervisor name
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Client / Site
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Conducted on
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Task
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Location
Part 1 : Get Safe for Work
Before you start Answer the beIow, f you answer No to any of the Following, please ensure that you inform the Responsible Persons and resolve Prior to Starting.
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Do you have the right documentation for the job? Risk Assessments, Permits and Method Statements. <br><br>
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Does the MEWP have an up to date certificate and the operator have an up to date IPAF license?
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Do you have the right PPE for the job?<br><br>
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Are scaffolds and towers inspected? <br>
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Is there Safe Access?<br>
Part 2 : Think - Act
If you Think the Task Requires additional controls - Select At Risk, Describe what is needed prior to commencing work. Implement the Controls and Continue
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Slips, trip or fall on the same level hazard?
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Falls From Height
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Falling or flying objects Hazard?
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Chemical/Harmful Substances
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Heat/Fire/Explosion/Hot works
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Asphyxiation / Drowning
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Risk to Plant<br>
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Stationary objects Contact Risk
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Overturn/Collapse
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Manual handling<br>
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Insecure load<br>
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Vehicle/ Contactor exclusion Risk<br>
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Contractor /Contractor exclusion Risk<br>
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Confined spaces (Permit Req’d)<br>
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Dust/Fumes<br><br>
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Noise<br><br>
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Vibration<br><br>
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Electricity<br><br>
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Radiation<br><br>
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Contamination<br><br>
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Poor lighting<br><br>
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Temperature<br>
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Adverse weather<br>
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Pinch/ Trapping Points<br>
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Dust/Fumes<br>
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Others Please specify
Part 3 : Review
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Has the Works created any New Hazards<br>
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Are there any lesson that were learn from the days Works<br>
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Are there any further safety Suggestions or Concerns Regarding the the days proceedings that you would like to communicate to Management?
