Title Page
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Person i/c Task
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Contact No.
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Date and Time
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Location
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Site Name
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Permit No
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Task/Job
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1. Access & Egress
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2. Adverse Weather (Wind etc)
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3. Communications – Contractors
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4. Confined Space
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5. Contractors (Above/Below)
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6. Crush (Machinery/Workplace)
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7. Energy Isolation (LOTO)
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8. Entanglement (Loose Clothing etc)
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9. Explosion (Substances)
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10. Eye Hazards
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11. Falling Objects
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12. Fire Risks
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13. Health Hazards - CV19/Fumes/Dust
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14. Hearing Hazards
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15. Hot Surfaces
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16. Leakages (Fuel - Gas - Fumes)
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17. Lifting Equipment
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18. Lifting Operations
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19. Roof Work (Leading Edges)
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20. Scaffold Inspected/ In date
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21. Sharps (Hand Tools etc)
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22. Slings – Chains – Hoists
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23. Slips & Trip (Footing etc)
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24. Tool Hazards
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25. Vehicle Movements
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26. Vehicle Movements Plant
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27. Welding & Hot Works
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28. Work at Heights
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29. Workers - Inexperienced
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30. Workers - Young/Lone
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Additional Information
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Reviewed By (Name and Signature)
Operative
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Name and Signature
