Title Page
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Document No
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Conducted on
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Location
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Prepared by
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Names of other people involved
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Description of task
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Location of task
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Take photo of task
Identify Hazards
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Can I strain or over exert myself?
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Please enter control measure
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Can I fall from a height
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Please enter control measure
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Can I be trapped/caught by plant
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Please enter control measure
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Is there a risk from chemicals
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Please enter control measure
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Can I receive burns (hot and cold)
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Please enter control measure
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Is there risk of fire
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Please enter control measure
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Can I slip/trip/fall
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Please enter control measure
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Does stored energy need isolating
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Please enter control measure
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Are there sharp edges or rotating parts
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Please enter control measure
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Am I working with radiation
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Please enter control measure
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Does my work impact others
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Please enter control measure
Identify Hazards
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Am I fit for the job
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Please enter control measure
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Am I trained and authorised
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Please enter control measure
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Am I aware of site emergency procedures
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Please enter control measure
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Site emergency contact details
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Do I need PPE
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Please enter control measure
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Do I need a work permit
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Please enter control measure
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Do I need to restrict access
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Please enter control measure
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Do I have safe access and egress
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Please enter control measure
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Do I need an MSDS
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Please enter control measure
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Any other concerns?
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Please enter control measure
