Title Page

  • Site conducted

  • Site address
  • Complete Daily Pre-start using one or more of the following controls

  • Conducted on

  • Prepared by

  • Job Number

  • Weather (if working outdoors)

Hazards

Hazards (only select what is relevant to today)

  • Traffic, pedestrians, EWPs & plant

  • Select all relevant controls (at least one)

  • Overhead / underground services

  • Select all relevant controls (at least one)

  • Hazardous substances

  • Select all relevant controls (at least one)

  • Work at Heights

  • Select all relevant controls (at least one)

  • Repairs to existing / new roof

  • Select all relevant controls (at least one)

  • Manual Handling (large objects)

  • Select all relevant controls (at least one)

  • Reversing on site

  • Select all relevant controls (at least one)

  • Rain, fog, high winds

  • Select all relevant controls (at least one)

Environment

  • Contamination / leakage

  • Select all relevant controls (at least one)

  • Noise / vibration / community / heritage items

  • Select all relevant controls (at least one)

  • Emergency preparedness

  • Select all relevant controls (at least one)

Checklist

Checklist

  • Scope of works discussed with crew

  • SWMS available

  • Plant| Equipment Inspections is completed

  • Emergency procedures available

  • Incident Management Procedures known

  • Materials received sign off received

  • Prestart meeting completed

  • Permits completed

  • Qualifications, Training and Competency Verified

Permit to work

  • Hot Works

  • Exclusion zones

  • Working at Heights

  • High Risk Construction Works

Rescue Plan / Working at Heights Permit / Working alone

Rescue Plan / Working at Heights Permit

  • Has a Rescue Plan been completed for this site and is it still current

  • Are you working from EWPs or in Fall Arrest

  • Please select what activity you are doing

Rescue Plan

  • How accessible is the location in an emergency

  • What are the access issues?

  • Is there an issue with housekeeping or uneven ground

  • What are the issues?

  • How can workers communicate to people outside the work area in an emergency

  • How will the alarm be raised and by whom

  • Rescue & emergency personnel can access the workplace during night shift, weekends and holiday periods

  • What kinds of emergencies are contemplated

  • If "Other" explain further

  • If "EWP failure" select rescue options

  • If "Other" explain further

  • If "Driver incapacitated" select rescue options

  • If "Other" explain further

  • The provision of suitable rescue equipment will depend on the potential emergencies identified. Select type of rescue equipment needed to effect the rescue.

  • If "Other" explain further

  • Are the rescuers properly trained and sufficiently fit to carry out their task.

  • Is appropriate First Aid available and someone trained to administer if required.

  • How will local emergency services be notified of an incident.

  • Any other information emergency services need to know (plant in area, cranes, trenches, allergies)

  • Supervisor / Person In Charge

Working at Height Permit

  • Work location

  • Supervisor / Person In Charge responsible for task

  • Worker/s name/s undertaking the task

  • Task description

  • Plant & Equipment to be used

  • Training and competencies to carry out works

Access /Egress

  • Safe access to work areas for all employees in place

  • Firm level ground for EWP / mobile access plant

  • Overhead services have been identified & communicated or isolated

  • Systems for the safe removal of waste materials are in place

Fall Prevention / Protection System

  • Exclusion Zone established around work area

  • An appropriate fall restraint / arrest system has been installed by suitably competent person

  • An appropriate full body harness / lanyard / ropes have been selected and inspected for the task

  • Tools and materials secured against falls

  • Authorised by

  • Issue Date

  • Expiry Date

Working Alone

  • Are there any isolated works or are you working alone

  • What is the length of time the worker may be alone

  • What time of day are they required to work alone

Potential Hazards

  • Mobile phone contact is available at all times

  • How will the alarm de raised in an emergency

  • Designated contact times have been established with the office

  • What is the time interval (in minutes)

  • Will the emergency communication system work properly in all situations

  • Is the work in a remote location that makes immediate rescue from emergency services difficult

  • How will this be remedied

  • What is likely to happen if there is a vehicle breakdown

  • What machinery, tools and equipment may be used

  • Are high risk activities involved

  • What controls are to be used

  • Is fatigue likely to increase risk (eg: long driving hours)

  • Is there an increased risk of violence or aggression when workers have to deal with clients or customers by themselves

  • Can environmental factors affect the safety of the worker (exposure to hot or cold environments)

  • What controls are in place for this

  • Is there a risk of attack by animals - including reptiles, insects

  • Does the worker have the required training for the works

  • Can the worker able to make sound judgements about their own safety

  • Are there any pre existing medical conditions that may increase risk

  • Please list

  • Reviewed by

  • Does a manager need to be notified

  • Have they been notified

Safe Work Method Statements (SWMS) | Safe Systems of Work such as SOPS or SWPs

  • Any additional hazards and associated risks identified not covered in SWMS

  • Use the Risk Matrix pictured to complete the Risk Assessment below for items not covered by the SWMS

  • Hazard
  • What are the hazards and risks

  • Risk Score before controls (refer to matrix)

  • What controls will be implemented

  • Risk score after controls in place (refer to matrix)

  • Supervisor / Person In Charge

Acknowledgement and Signatures

  • Attendee Acknowledgement:
    NOTE: by signing below you agree to the following points:
    1. I have read and understand this Daily Pre-Start|Tool Box|Work Plan and will work in accordance with the above
    2. I will consult with the Supervisor / PIC if changes are required and assist in re-issuing this form if required.
    3. I have been consulted on the specific safety and environmental requirements of the activity.
    4. I understand that I am responsible for my own and fellow workers safety.
    5. I have ticked the Fit 4 Work acknowledging that I am indeed fit for work and not affected by fatigue, alcohol or prescription or other drugs.

  • Supervisor / Person In Charge

  • Attendee
  • I am Fit 4 Work

  • Name

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.