Pre-Work Risk Assessment

• Document No. (Auto Generated)

• Client / Site / Customer Name

• Location
  Address

• Conducted on (Start Date)

  Date

• Prepared by

• Customer Representative / Site Contact (Health & Safety)

Work condition

• Is the work to be carried out

  Select Routine Commissioning / Maintenance Emergency Breakdown Service Work Applications Activities As described in Buhler UK Ltd documentation (Manuals, checklists etc.) Other - requiring a written method statement

  • Routine Commissioning / Maintenance
  • Emergency Breakdown Service Work
  • Applications Activities
  • As described in Buhler UK Ltd documentation (Manuals, checklists etc.)
  • Other - requiring a written method statement

• Risk Assessments

• Which of the following risk assessments apply

  Select Vehicle Movement Dust Noise Ladders & Step Ladders Compressed Air - Sortex Machines Live Plant Working Use of Extensions and trailing Leads Electrical panel and device work Lighting Slip and trip hazards Falling objects Manual Handling Use of Knives & Hand tools Working at height Work on Machinery

  • Vehicle Movement
  • Dust
  • Noise
  • Ladders & Step Ladders
  • Compressed Air - Sortex Machines
  • Live Plant Working
  • Use of Extensions and trailing Leads
  • Electrical panel and device work
  • Lighting
  • Slip and trip hazards
  • Falling objects
  • Manual Handling
  • Use of Knives & Hand tools
  • Working at height
  • Work on Machinery

• Does a supplementary risk assessment sheet need to be filled in

  Yes

  No

  N/A

• Please attach the completed document or a photo of the document is required

  Yes

  No

  N/A

• Have Site work Permits been issued and signed

  Yes

  No

  N/A

PPE Requirements

• Is PPE Required

  Yes

  No

  N/A

• Hard Hat

  Select Mandatory When additional PPE is required for the task N/A

  • Mandatory
  • When additional PPE is required for the task
  • N/A

• Overalls

  Select Mandatory When additional PPE is required for the task N/A

  • Mandatory
  • When additional PPE is required for the task
  • N/A

• RPE (Dust &/or Fume face mask)

  Select Mandatory When additional PPE is required for the task N/A

  • Mandatory
  • When additional PPE is required for the task
  • N/A

• Safety Shoes / Boots

  Select Mandatory When additional PPE is required for the task N/A

  • Mandatory
  • When additional PPE is required for the task
  • N/A

• Ear Defenders / Protection

  Select Mandatory When additional PPE is required for the task N/A

  • Mandatory
  • When additional PPE is required for the task
  • N/A

• Safety Glasses

  Select Mandatory When additional PPE is required for the task N/A

  • Mandatory
  • When additional PPE is required for the task
  • N/A

• Hi Viz Vest / Jacket

  Select Mandatory When additional PPE is required for the task N/A

  • Mandatory
  • When additional PPE is required for the task
  • N/A

• LOTO Kit Required

  Select Mandatory When additional PPE is required for the task N/A

  • Mandatory
  • When additional PPE is required for the task
  • N/A

Sign Off

• Service Engineer Print Name

• Signature

  Sign