Title Page

  • Business Name

  • Business Logo

  • Document number

  • Where is work to be completed ?

  • Location
  • Photo of location

  • Conducted on

  • Prepared by

  • Date work commences

  • Date work finishes

  • Supervisor for Work being completed

  • Description of work to be completed

  • Names of people carrying out the work

  • Total number of workers

Risk Assessment

    Hazard, Risks and Controls
  • What is the hazard?

  • Who Might be Harmed

  • What are the control measures?

  • What is the likelihood?

  • What are the consequences?

  • What is the risk level?

  • Is the risk level acceptable?

  • Specify the extra control measures required to ensure the risk level becomes acceptable.

References

  • Risk Matrix Reference

  • Hierarchy of Controls Reference

Method Statement

Training

  • Specify the training

Tools and Equipment

  • undefined

PPE

  • Requirements

First Aid

  • Requirements

Emergency Procedures

  • Requirements

Welfare Requirements

  • Welfare Arrangements

  • First Aid Arrangements

Environmental and Waste Management

  • Arrangements

  • Do you need a Permit to Work?

  • Specify the PTW required

Procedure Before Work Commences

  • What do you need to do ?

  • Specify

Procedures During the Work

  • How are you going to do the work?

Procedure at the End of Works

  • What do you need to do?

Completion

  • Are there any other issues that might need to addressed in future

  • Specify

  • Signature

  • Staff Sign Off
  • Name

  • Signature

  • Date

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.