Title Page

  • Visit Start Date:

  • Prepared by

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

  • Ship Name

  • Task Description

Required Documents

  • 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

  • 2. Method statement available

  • 3. Risk Assessment available

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

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

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

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

Site Safety Awareness

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

  • 4a. Were you given a copy

  • Did you sign a declaration following the briefing?

  • 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

  • 8. I know how to reach the site contact

  • 9. I know how an emergency is signalled

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

  • 11. I know the evacuation route and assembly point

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

  • 13. I am aware of my authorised working area

  • 14. I am aware of any restricted areas

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

  • 16. Working time limits are agreed and understood

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

Tools and Equipment

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

  • 19. Hand tooling is in good condition

  • 20. Power tools to be used?

  • 20a. Power tools are in good condition

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

  • 21. Work will involve climbing

  • 21a. Safety harness to be used?

  • 21b. Training for activities within date

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

  • 21d. Rescue kit available

  • 21e. Rescue kit within inspection cycle

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

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

Work Area

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

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

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

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

  • 28. Are weather conditions likely to increase the risks

  • 28a. Have safe working limits been agreed


  • 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.

  • I consider the work area to be

  • 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.

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.