Remote Pre-Work Checklist

• Visit Start Date:

  Date

• Prepared by

• Location
  Address

• Unique Identifier (e.g. Scope Number etc.)

• Ship Name

• Task Description

• All questions must be answered before work can commence. Answering N/A to any question requires justification in the comments.

Required Documents

• 1. Scope of work available

  Yes

  No

  N/A

• 2. Method statement available

  Yes

  No

  N/A

• 3. Risk Assessment available

  Yes

  No

  N/A

• 3a. All aspects of the scope of works are covered by Risk Assessment?

  Yes

  No

  N/A

• 3b. All anticipated Health & Safety hazards covered by RAMs?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 3c. All anticipated Environmental hazards covered by RAMs?

  Yes

  No

  N/A

• 3d. I understand how to report an accident/incident/near-miss to my Manager

  Yes

  No

  N/A

Site Safety Awareness

• 4. Received briefing on site rules and safety from the site coordinator

  Select Verbal Written None

  • Verbal
  • Written
  • None

• 4a. Were you given a copy

  Yes

  No

• Did you sign a declaration following the briefing?

  Yes

  No

  N/A

• 5. Name of the relevant safety contact for this visit:

• 6. Contact details (phone/email) of safety contact.

• 7. I understand all the site specific safety instructions I've received

  Yes

  No

  N/A

• 8. I know how to reach the site contact

  Yes

  No

  N/A

• 9. I know how an emergency is signalled

  Yes

  No

  N/A

• 10. I know how to raise the alarm in the event of an emergency

  Yes

  No

  N/A

• 11. I know the evacuation route and assembly point

  Yes

  No

  N/A

• 12. I know when/how to report an Incident/accident/injury to the site contact

  Yes

  No

  N/A

• 13. I am aware of my authorised working area

  Yes

  No

  N/A

• 14. I am aware of any restricted areas

  Yes

  No

  N/A

• 15. I know where the rest areas are to take my breaks

  Yes

  No

  N/A

• 16. Working time limits are agreed and understood

  Yes

  No

  N/A

• 17. I'm aware of walking routes and areas

  Yes

  No

  N/A

Tools and Equipment

• 18. Use of all tooling and equipment required to fulfil the scope is covered in the RAMs

  Yes

  No

  N/A

• 19. Hand tooling is in good condition

  Yes

  No

  N/A

• 20. Power tools to be used?

  Yes

  No

• 20a. Power tools are in good condition

  Yes

  No

  N/A

• 20b. PAT in date (if mains powered)?

  Yes

  No

  N/A

• 21. Work will involve climbing

  Yes

  No

• 21a. Safety harness to be used?

  Yes

  No

• 21b. Training for activities within date

  Yes

  No

  N/A

• 21c Harnesses/fall arrest and all other associated equipment within inspection cycle

  Yes

  No

  N/A

• 21d. Rescue kit available

  Yes

  No

  N/A

• 21e. Rescue kit within inspection cycle

  Yes

  No

  N/A

• 22. Ladders/portable steps will be inspected prior to use

  Yes

  No

  N/A

• 23. Mechanical lifting aids will be inspected prior to use

  Yes

  No

  N/A

Work Area

• 24. Has provision been made for suitable 3rd party transport to and from site (N/A if not required)

  Yes

  No

  N/A

• 25. Area has been inspected for hazards prior to work

  Yes

  No

  N/A

• 26. Others in the area are aware of the potential hazards from work being carried out

  Yes

  No

  N/A

• 27. It is possible to implement the controls as per the RAMs

  Yes

  No

  N/A

• 28. Are weather conditions likely to increase the risks

  Yes

  No

• 28a. Have safe working limits been agreed

  Yes

  No

  N/A

Declaration

• Comments

• I herby confirm that the above statements are accurate and that the work will be carried out according to the RAMs. If necessary to make dynamic changes to the method, these will be considered for safety implications before continuing and recorded as soon as possible on this form or the site visit report.

  Sign

• I consider the work area to be

  Safe

  At Risk

• You may commence work in accordance with the RAMs

• Do not continue. Resolve the issue(s) with your site contact or discuss with your manager if necessary.