POWRA

• Document No.

• Prepared By

• Job Number

• Customer

• Location
  Address

• Activity / Task To Be Carried Out

• Conducted on

  Date

• Number Of Persons Exposed To Risk

• Who Will Be Put At Risk

  Select Workers Adjacent Workers Public Visitors Others

  • Workers
  • Adjacent Workers
  • Public
  • Visitors
  • Others

Part 1 - Before You Start Work

• Do you have the work instruction & been to the Permit Office to get approval?

  Yes

  No

  N/A

• Do You Have The Right Tools For The Job?

  Yes

  No

  N/A

• Are the tools that are required in calibration in date? (PAT)

  Yes

  No

  N/A

• Do you have the correct documentation? (RAMS, COSHH, Etc.)

  Yes

  No

  N/A

• Have you read, understood, signed and agreed to comply with the documentation?

  Yes

  No

  N/A

• Do you have the right PPE?

  Yes

  No

  N/A

• Are all scaffolds, ladders etc. inspected and in date?

  Yes

  No

  N/A

• Are you competent to carry out the works required?

  Yes

  No

  N/A

• Do you require any additional inductions to enter the work area? If so have you taken them?

  Yes

  No

  N/A

• If you have answered 'NO' to any of the above DO NOT start work and see you're supervisor!

Part 2 - Safety Assessment (If The Hazard Is Present Select 'At Risk' and then state additional actions to reduce the risk to a safe level, If you are unable to reduce the risk to Safe then DO NOT start work and see your Supervisor!)

• Slips, Trips & Falls

  Safe

  At Risk

  N/A

• Working At Height

  Safe

  At Risk

  N/A

• Falling Objects

  Safe

  At Risk

  N/A

• Hot Works (inc. cutting)

  Safe

  At Risk

  N/A

• Asbestos

  Safe

  At Risk

  N/A

• Manual Handling

  Safe

  At Risk

  N/A

• Confined Spaces

  Safe

  At Risk

  N/A

• Dust, Fumes Etc.

  Safe

  At Risk

  N/A

• Noise

  Safe

  At Risk

  N/A

• Vibration

  Safe

  At Risk

  N/A

• Electricity

  Safe

  At Risk

  N/A

• Lighting

  Safe

  At Risk

  N/A

• Temperature

  Safe

  At Risk

  N/A

• Weather (Rain, Wind Etc.)

  Safe

  At Risk

  N/A

• Vehicles

  Safe

  At Risk

  N/A

• Services

  Safe

  At Risk

  N/A

• Other - Is there any other risks on site that can foreseen

  Safe

  At Risk

  N/A

Authorisation To Commence Work

• Signature

  Sign