Pre Work Survey Check Sheet

• Select date

  Date

Safe Place of Work

• Is there a safe access for all on site to reach their place of work ie good roads, gangways, passageways, hoists, staircases, ladders and scaffolds?

  Safe

  At Risk

  N/A

• Is artificial lighting required on site?

  Yes

  No

  N/A

• Are there proper arrangements for the disposal of waste?

  Yes

  No

  N/A

• Other hazards

  Yes

  No

  N/A

Working at Height

• Is adequate types of access in place? Ie crawl boards/ladders etc?

  Yes

  No

  N/A

• Edge protection for materials/people?

  Yes

  No

  N/A

• Are there roof lights?

  Yes

  No

  N/A

• Are people working below requiring protection from falling objects?

  Yes

  No

  N/A

• Is scaffolding required?

  Yes

  No

  N/A

• Does the scaffolding require permits?

  Yes

  No

  N/A

• Is MEWP necessary?

  Yes

  No

  N/A

Electricity

• Is there an electric underground cable near the work being carried out, has it been located and marked and precautions take to avoid contact?

  Yes

  No

  N/A

• Are there overhead lines within confine of site?

  Yes

  No

  N/A

Mobile Plant

• Has location been identified for the storage of onsite plant and equipment?

  Yes

  No

  N/A

• Would the equipment noise output have a significant impact on the surrounding environment?

  Yes

  No

  N/A

• Is general noise going to be a problem during site access/egress and on site?

  Yes

  No

  N/A

Health Risks

• Have harmful materials been identified?

  Yes

  No

  N/A

• Safety equipment required PPE?

  Yes

  No

  N/A

• Are protective measures required within the work areas?

  Yes

  No

  N/A

• Is confined space works required?

  Yes

  No

  N/A

• Is dust screening required?

  Yes

  No

  N/A

• HA vibrations?

  Yes

  No

  N/A

Risks to the public

• Does the work create risks to members of the public? Eg materials falling, site plant, access and egress

  Yes

  No

  N/A

• Is the site perimeter fencing adequate to keep out the public?

  Yes

  No

  N/A

• Is the site secure during non working hours and periods?

  Yes

  No

  N/A

Welfare

• Are there toilets?

  Yes

  No

  N/A

• Are there wash basins, hot water, soap and towels?

  Yes

  No

  N/A

• Is there a room or area where clothes can be dried?

  Yes

  No

  N/A

• Is there a room where workers can shelter and have meals with facilities to boil water?

  Yes

  No

  N/A

• Is there a supply of drinking water provided?

  Yes

  No

  N/A

Fire and emergencies

• Are hot works going to be carried out?

  Yes

  No

  N/A

• Fire extinguishers required?

  Yes

  No

  N/A

• Additional escape routes?

  Yes

  No

  N/A

Compressed gases

• Are cylinders to be stored on site?

  Yes

  No

  N/A

Traffic routes and vehicles

• Does the work require traffic management?

  Yes

  No

  N/A

• Is there suitable parking for onsite vehicles?

  Yes

  No

  N/A

Environmental

• Is a water course on site?

  Yes

  No

  N/A

• Is there flora or fauna protection of planted areas?

  Yes

  No

  N/A

• Is it a Cultural Heritage area?

  Yes

  No

  N/A

• Are there endangered or protected species?

  Yes

  No

  N/A

• Is the building listed or protected?

  Yes

  No

  N/A

Existing Infrastructure

• Are there existing structures close to the worksite that may be damaged by the works?

  Yes

  No

  N/A

• Is there existing cabling and equipment close to the worksite that may be damaged by the works?

  Yes

  No

  N/A

Worksite

• Sketch detailing the proximity of worksite to existing infrastructure.

  Drawing

• Additional information

• Signature

  Sign