Title Page

  • Visit Type

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • VI Support Personnel

  • Other Personnel

1.0 SITE INDUCTION

  • 1.1 Have you had a site induction?

  • Please include photo of working area

  • 1.2 Are you the only VI engineer on site and are you out of constant view and audible range of a customer employee?

  • Stop and Think. You are at risk because you are lone working. Be aware of handling equipment safely and ensure that a customer is aware of where you are working and how long your work will take.

    stop-and-think-sign-stop-and-think-xJZvwa-clipart.jpg

2.0 WORKING AT HEIGHT

  • 2.1 Will the job require working at height?

  • 2.11 Do you have adequate access equipment that safely negates the need for harnesses?

  • Please upload a photo of the access equipment, preferably in place of use.

  • 2.12 Will you be able to work with a Lanyard Harness PREVENTING fall from height?

  • STOP - THIS TASK MUST NOT BE CARRIED OUT WITHOUT RISK ASSESSMENT

    stop-and-think-sign-stop-and-think-xJZvwa-clipart.jpg

3.0 ENVIRONMENT

  • 3.1 Is the Working Area clean and tidy? <br><br>For example - <br>Bird/rodent droppings<br>Significant clutter blocking exits

  • Stop and Think. Refuse to carry out the work if in doubt.

    stop-and-think-sign-stop-and-think-xJZvwa-clipart.jpg
  • 3.2 Is there significant noise pollution?

  • Stop and Think - if the noise level is high wear ear protection. If in doubt ear protection must be worn

    stop-and-think-sign-stop-and-think-xJZvwa-clipart.jpg

4.0 OTHER

  • 4.1 Have you carried out sufficient isolation?<br>Electrical and to prevent the system being started.

  • This task must not be carried out if the system isn't isolated correctly. If in doubt please contact your supervisor. Please add detail as to why it wasn't possible to correctly isolate the system.

  • 4.2 Do you see any other risks that need noting?

  • Please include as much detail as possible. If you believe you are at risk do not continue. If in doubt stop.

  • Please upload a photo

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.