Pre Start Site Assessment Form

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Site Details

• Site Address
  Address

• CLIENT:

• Select date

  Date

• SITE ACCESS:

• Site Times

• PARKING:

• Site Contact & Tel No

Isolations

• Are there any live services effected by the works?

  Yes

  No

  N/A

• SERVICES To Be Isolated By Whom?

Utilities

• LIGHTING?

• POWER?

• WATER?

• WELFARE?

• ACCESS EQUIPMENT?

• Other Contractors On Site?

RISKS

• Working At Height?

  Safe

  At Risk

  N/A

• Confined Space

  Safe

  At Risk

  N/A

• Slips, Trips & Falls

  Safe

  At Risk

  N/A

• Manual Handling

  Safe

  At Risk

  N/A

• Poor Lighting

  Safe

  At Risk

  N/A

• Electric, Plant & Equipment

  Safe

  At Risk

  N/A

• Noise

  Safe

  At Risk

  N/A

• HAVS

  Safe

  At Risk

  N/A

• Fire

  Safe

  At Risk

  N/A

• Needles & Sharps

  Safe

  At Risk

  N/A

• Vehicle Movement

  Safe

  At Risk

  N/A

• Live SERVICES ( Electrical )

  Safe

  At Risk

  N/A

• Live SERVICES ( Gas )

  Safe

  At Risk

  N/A

• Live SERVICES ( Water )

  Safe

  At Risk

  N/A

• Live SERVICES ( Other )

  Safe

  At Risk

  N/A

• Bio Hazards ( infestation / Guano )

  Safe

  At Risk

  N/A

• Leptospirosis

  Safe

  At Risk

  N/A

• Public

  Safe

  At Risk

  N/A

• Weather Conditions

  Safe

  At Risk

  N/A

Job Particulars

• Any Special Requests From The Client

  Yes

  No

  N/A

• Type of Asbestos works

  Select Licenced Non Licenced Notifiable Non Licenced

  • Licenced
  • Non Licenced
  • Notifiable Non Licenced

• Number of Operatives

• Number of Supervisors

• Number of Days

• Weekend Working

  Yes

  No

  N/A

• Night Working

  Yes

  No

  N/A

• Analytical Requirements

  Yes

  No

  N/A

• Type of Asbestos on This Project

  Select Chrysotile Amosite Crocidolite

  • Chrysotile
  • Amosite
  • Crocidolite

• How is the Asbestos Fixed

• Number of Enclosures

  Select 1 2 3 4 5

  • 1
  • 2
  • 3
  • 4
  • 5

• AREA 1 Dimensions & NPU calculations

• Enclosure construction AREA 1

• Airlock & Baglock

• AREA 1 Sketch

  Drawing

• Quantity of Asbestos & Condition

• AREA 1

  Media

• AREA 2 Dimensions & NPU calculations

• Enclosure construction AREA 2

• Airlock & Baglock

• AREA 2 Sketch

  Drawing

• Quantity of Asbestos & Condition

• AREA 2

  Media

• AREA 3 Dimensions & NPU calculations

• Enclosure construction AREA 3

• Airlock & Baglock

• AREA 3 Sketch

  Drawing

• Quantity of Asbestos & Condition

• AREA 3

  Media

• AREA 4 Dimensions & NPU calculations

• Enclosure construction AREA 4

• Airlock & Baglock

• AREA 4 Sketch

  Drawing

• Quantity of Asbestos & Condition

• AREA 4

  Media

• AREA 5 Dimensions & NPU calculations

• Enclosure construction AREA 5

• Airlock & Baglock

• AREA 5 Sketch

  Drawing

• Quantity of Asbestos & Condition

• AREA 5

  Media

• Job Discription

• Control Measures

  Select Dust suppression Shadow Vacuuming RPE Enclosure under Negative Pressure Needle Injection Wrap & Cut

  • Dust suppression
  • Shadow Vacuuming
  • RPE
  • Enclosure under Negative Pressure
  • Needle Injection
  • Wrap & Cut

• Decontamination

  Select DCU Trailer Modular Localised Decontamination (Bucket/Sponge)

  • DCU Trailer
  • Modular
  • Localised Decontamination (Bucket/Sponge)

• RPE for this Project

  Select Half Mask with P3 Filter Full Face Powered Respirator Air Fed

  • Half Mask with P3 Filter
  • Full Face Powered Respirator
  • Air Fed

• PPE For This Project

  Select Hard Hat Hi Vis Vest Hi Vis Trousers Gloves Safety Boots Safety Glasses Ear Defenders

  • Hard Hat
  • Hi Vis Vest
  • Hi Vis Trousers
  • Gloves
  • Safety Boots
  • Safety Glasses
  • Ear Defenders