Title Page

  • Document No.

  • Conducted on

  • Conducted by

  • Names of other people involved

  • Location
  • Description of task

  • Location of task

Identify Hazards

  • Photo of task

  • Can i strain or over exert myself?

  • Please enter control measure

  • Can i fall from a height?

  • Please enter control measure

  • Can i be trapped/caught by plant?

  • Please enter control measure

  • Is there a risk from chemicals?

  • Please enter control measure

  • Can i recieve burns (hot or cold)?

  • Please enter control measure

  • Is there a risk of fire?

  • Please enter control measure

  • Can i slip, trip or fall?

  • Please enter control measure

  • Does stored energy need isolating?

  • Please enter control measure

  • Are there sharp edges and rotating parts?

  • Please enter control measure

  • Am i working with radiation?

  • Please enter control measure

  • Does my work impact others?

  • Please enter control measure

Identify Hazards

  • Am i fit for the job?

  • Please enter control measure

  • Am i trained and authorised to perform the task?

  • Please enter control measure

  • Am i aware of site emergency procedures?

  • Please enter control measure

  • Site emergency contact details

  • Do i require PPE?

  • Safety glasses

  • Safety boots

  • Long sleeves and pants

  • Goggles

  • Face shield

  • Splash apron

  • Nitrile gloves

  • Double layer gloves

  • Leather gloves

  • Chemical suit

  • Chemical boots

  • Cutting gloves

  • Hard hat

  • Sun protection

  • Dust suit

  • Hearing protection

  • Respirator

  • Hearing protection

  • Other PPE

  • Do i require a work permit (hot work, confined space, etc.)?

  • Please enter control measure

  • Do i need to restrict access to the work area?

  • Please enter control measure

  • Do i have safe access and egress?

  • Please enter control measure

  • Do i need an SDS?

  • Please enter control measure

  • Any other concerns?

  • Please enter control measure

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.