Title Page

  • Supervisor name

  • Job Number

  • Conducted on

  • Task

  • Site Attendees

  • 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.

  • Do you have the right documentation for the job? Risk Assessments, Permits and Method Statements. <br><br>

  • Are the power tools and leads tested?<br><br>

  • Do you have the right PPE for the job?<br><br>

  • Are scaffolds and towers inspected? <br>

  • 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

  • Slips, trip or fall on the same level hazard?

  • Control Measures

  • Residual risk

  • Falls From Height

  • Control Measures

  • Residual Risk

  • Falling or flying objects Hazard?

  • Control Measures

  • Residual Risk

  • Chemical/Harmful Substances

  • Control Measures

  • Residual Risk

  • Heat/Fire/Explosion/Hot works

  • Control Measures

  • Residual Risk

  • Risk to Plant<br>

  • Control Measures

  • Residual Risk

  • Stationary objects Contact Risk

  • Control Measures

  • Residual Risk

  • Overturn/Collapse

  • Control Measures

  • Residual Risk

  • Manual handling<br>

  • Control Measures

  • Residual Risk

  • Insecure load / Stored Energy<br>

  • Control Measures

  • Residual Risk

  • Vehicle/ Contractor exclusion Risk<br>

  • Control Measures

  • Residual Risk

  • Confined spaces (Permit Req’d)<br>

  • Control Measures

  • Residual Risk

  • Dust/Fumes<br><br>

  • Control Measures

  • Residual Risk

  • Noise<br><br>

  • Control Measures

  • Residual Risk

  • Vibration<br><br>

  • Control Measures

  • Residual Risk

  • Uncertified Equipment

  • Control Measures

  • Residual Risk

  • Poor lighting<br><br>

  • Control Measures

  • Residual Risk

  • Temperature<br>

  • Control Measures

  • Residual Risk

  • Adverse weather<br>

  • Control Measures

  • Residual Risk

  • Pinch/ Trapping Points<br>

  • Control Measures

  • Residual Risk

  • Dust/Fumes<br>

  • Control measures

  • Residual Risk

  • Animals

  • Control measures

  • Residual Risk

  • Drowning or Asphyxiation

  • Control measures

  • Residual Risk

  • Electricity

  • Control Measures

  • Residual Risk

  • Others Please Specify

  • Control Measures

  • Residual Risk

Part 3 : Review

  • Have the works created any New Hazards<br>

  • Control Measures

  • Are there any lesson that were learn from the works<br>

  • Lessons to be learned :

  • Are there any further safety Suggestions or Concerns Regarding the the days proceedings that you would like to communicate to Management?

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.