Preliminary Hazard ID

• Location
  Address

• Client

  Fletchers EQR

  HNZ

  Overcap

  Stream

  Private Job

• Conducted on

  Date

• Prepared By

  Chris Brosnan

  Tony Ryan

  Jason Harvey

Hazards - Will any of the following will be present on-site during the repair?

• Standard Hazards - Power Tools, Noise, Dust, People, Ladders

  Present

  Not Present

• Dogs?

  Present

  Not Present

• Overhead Power Lines?

  Present

  Not Present

• Unkempt Environment?

  Present

  Not Present

• Cluttered Environment?

  Present

  Not Present

• Drug / Excessive Alcohol use?

  Present

  Not Present

• Tree Removal?

  Present

  Not Present

• Demolition of Building

  Present

  Not Present

• Excessive mud (including if it were a rainy day)?

  Present

  Not Present

• Uneven exterior walkways / ground?

  Present

  Not Present

• Working At Heights (Over 2.5M)?

  Present

  Not Present

• Children under 18 years old?

  Yes

  No

  N/A

• Work in Confined Space ( Roof Space or Under floor)?

  Present

  Not Present

• Type of work

  Select Jacking and Packing Electrical Plumbing Insulation Other (Specify in Comments)

  • Jacking and Packing
  • Electrical
  • Plumbing
  • Insulation
  • Other (Specify in Comments)

• Will there be Excavations?

  Present

  Not Present

• Depth of Excavation

  Less than 1.5 Metres Deep

  1.5 Metres Deep or more

• Notes

Significant Hazards - ie electrical, unkempt environmental, substances etc

• Is the tenant classified as HIGH RISK?

  Yes

  No

• Detail any concerns

• Are there any significant hazards to be remedied BEFORE starting work? ie Decant, electrical works to be carried out.

  Yes

  No

• Details works / tasks

Asbestos

• Electrical Fuse Board

  Test Required

  Suspected ACM unrelated to works

  Not checked - unrelated to work

  Not Present

• Vinyl / Lino Flooring

  Test Required

  Suspected ACM unrelated to works

  Not checked - unrelated to work

  Not Present

• Insulation (Loose fill Insulation)

  Test Required

  Suspected ACM unrelated to works

  Not checked - unrelated to work

  Not Present

• Other Potential ACM

  Test Required

  Suspected ACM unrelated to works

  Not checked - unrelated to work

  Not Present

• Stipple Ceilings

  Test Required

  Suspected ACM unrelated to works

  Not checked - unrelated to work

  Not Present

• Cement Sheeting (Shingles, Soffits etc)

  Test Required

  Suspected ACM unrelated to works

  Not checked - unrelated to work

  Not Present