Title Page

  • Conducted on

  • Prepared by

  • Signature

  • Location


  • Placed travel trip and plan into Outlook calendar

  • Travel approved by Manager

  • Correct vehicle type (if travelling on dirt roads for long distances, take a suitable equipped 4WD vehicle)

  • Weather conditions checked and assessed whether safe to travel

  • Vehicle pre-start check conducted (vehicle is within service interval, sufficient fuel, check tyres, clean windscreen, fuel cards available)

  • First Aid kit available

  • Correct PPE worn (long sleeve shirt, long pants, hi-vis vest, lace-up safety boots, wide brim hat, sunscreen, gloves)

  • Have you read and signed Safe Work Method Statement - Regional Customer Service Field Work and Driving - West Region

  • Tool / Equipment required for the task

  • Has a visual inspection been conducted of tools and equipment?

Situational Awareness

  • Activity

  • Location
  • Time onsite

  • Description of work

  • Do you have phone coverage?

  • Are there pedestrians/traffic in close proximity to the task/work area?

  • Are there controls in place to protect the public and yourself?

  • Have you contacted your Manager if working alone, remote or isolated?

  • Parked clear of carriageway, minimum 3 metres if possible, to make/receive phone calls

  • Is the vehicle parked in an easily accessible area on flat even ground?

  • Is the area free from slips, trips and falls?

  • Are there any hazards on site not controlled by the existing Safe Work Method Statement?

  • What are the hazards?

Return to Base

  • Refuel vehicle and clean windscreen

  • Tidy/clean vehicle

  • Is there any damage or issues with the vehicle

  • Has the damage or issue been reported

  • Complete log book and return keys

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.