Title Page
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Conducted on
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Prepared by
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Location
Job Location
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Add location
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Does the work involved required protection of the public/vehicles
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Do you have the necessary paperwork to commence this job
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Does the work involved require working at height
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Are there any overhead power lines in the vicinity of the scaffold build
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If YES to the above question; have you informed your line manager that works cannot commence until clearance from the energy provider is obtained
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What do you need to do to make the ground conditions safe
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Is the work near schools/shops/pedestrian crossings
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If YES to the above question; do you have sufficient barriers to prevent pedestrian access to your work areas
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Please state what you require to protect your work area; CONES - CHAPTER 8 BARRIERS - WARNING TAPE - HERAS FENCING - SIGNS
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Are you working on or near MEWPS
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If YES to the above you must wear a Harness/Lanyard whilst on the MEWP, you must be qualified to use it and the area of work must be barriered off to prevent pedestrian access
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Are you working near water (river/canal/lake)
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If YES to the above question, you must inform the Health & Safety Team to advise them of your location and await instruction. Barriers must be put in place to protect the area
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Do you have the correct PPE to commence the work
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PPE consists of the following; Safety Boots / Hi-Viz clothing / Eye Protection / Gloves / Ear Protection / Face Mask / Hard Hat / Harness / Lanyard Please state the items you will need
Sign off to state you have completed the POWRA
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Select date
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Sign off to state that the area of work is safe to work in
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Select date
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