Title Page

  • Contractor / Site

  • Location
  • Site photo

  • Conducted on

  • Prepared by

  • Personnel

  • Type of work being undertaken

  • Please select work field

  • Document No


  • Does the operative have access to general RAMS?

  • Has the operative carried out a pre-start risk assessment to identify the relevant hazards and controls required?

  • Is a suitable Construction Phase Plan available?

  • Overview of project

  • Key personel

  • Arrangements specific to the project

Training and Briefing

  • Are operatives qualified and suitably trained for the tasks they are carrying out?

  • Has the operative undertaken Asbestos Awareness Training?

  • Are toolbox talks taking place?

  • What was the last topic?


  • Has the operative parked their vehicle safely, not causing an obstruction to traffic or pedestrians?

  • Is the operative wearing clear identification/name badge with photo ID?

  • Has the operative signed in using either a visitors book or contractor signing in sheet where applicable?


  • Asbestos in residential property

  • Will the scope of the work disturb the fabric of the building?

  • Are the materials to be worked on highly unlikely to contain asbestos (stone, brick, breeze-block and mortar, concrete, metal, glass or wood) or be concealing it?

  • Has the operative received appropriate information (either from LBE asbestos register or own survey) confirming asbestos is not present in the area being disturbed?

  • If a survey was carried out, was it by a company with suitable UKAS accreditation that was as intrusive as the works being undertaken?

  • Has ACM been removed or worked on by a HSE licensed asbestos contractor before refurbishment work commences?

  • For internal licensable work, was reassurance air testing carried out by an independent UKAS Accredited Air Monitoring Company?


  • Are appropriate CE marked PPE items available?

  • Goggles

  • Earplugs

  • Gloves

  • RPE (face mask - Filtering half mask i.e. disposable dust mask or half-mask respirator with replaceable filter cartridge for vapours and gases)

  • Safety footware

  • Is the PPE in good condition?

  • Is appropriate PPE being worn?

  • Where a half-mask filtering face piece is used, is face piece fit testing carried out?

  • Do staff know how to carryout a pre-use check of their RPE?

First Aid

  • Does the operative have access to a first aid kit that is in date?

  • Sterile plasters

  • Sterile eye pads

  • Triangular bandages

  • Safety pins

  • Sterile saline wipes

  • Disposable gloves

  • Does the operative have access to an eye wash station if required?

Work Equipment

  • Is work equipment in good condition (no signs of damage)?

  • Is work equipment and materials stored appropriately within the vehicle?

  • Is there evidence that work equipment is included on a maintenance log?

  • If abrasive wheels are used has the operative received training on mounting the wheels and general hazards?

  • Are cordless tools or tools that operate from a 110V supply system being used?

  • Are portable corded tools and chargers PAT tested?

  • Is any equipment used that requires periodic calibration?

  • Give details of the equipment
  • Please capture as much detail as possible

  • When was it last calibrated
  • Please capture as much detail as possible

  • Does this comply with legal/manufacturers requirements?


  • Are vibrating tools used?

  • Concrete breaker

  • Hammer drill

  • Grinder

  • Disc cutter

  • Sander

  • Other

  • Is there any indication that the equipment is included on a maintenance regime or log?

  • Tool
  • Type of tool

  • Manufacturer

  • Photo of tool

  • Description of task tool is used for

  • Vibration Magnitude (level) for the tool m/S2 (it is recommended that the declared value should be doubled when comparisons are made with exposure limits)

  • Typical exposure (finger on trigger) time over a day

  • What is the exposure time to reach the 'Limit Value' using HSE chart?

  • Is the Exposure Limit Value likely to be exceeded for this tool?

  • What is the exposure time to reach the 'Action Value' using HSE chart?

  • Is the Exposure Action Value likely to be exceeded for this tool?

  • Is there evidence that use of vibrating equipment has been risk assessed (including a soundly based estimate of the employees' exposure to vibration) and precautions (e.g. work patterns to reduce exposure time, warm clothing and training courses on use of equipment) taken to reduce risk identified?

  • Has the operative been informed of Hand-arm vibration diseases caused by exposure of the hand and arm to external vibration?

  • Does the operative suffer any of the following symptoms?

  • Tingling and numbness in the fingers after using equipment or some time after the end of the working shift

  • Experience the tops of their fingers going 'white' (vibration white finger) particularly on exposure to cold conditions

  • Experience loss of grip strength in their hands

  • Is the operative aware of whether they are included on a health surveillance programme for monitoring exposure to vibration e.g. issued with an annual HAV questionnaire (required where risk assessment indicates that there is a risk to the health of any employees who are or are liable to be exposed to vibration or employee is exposed to vibration at or above the Exposure Action Value)?

Work at Height

  • Does the scope of the work include activities where there is a need to control a risk of falling a distance liable to cause personal injury?

  • Has the task been risk assessed?

  • Is there evidence that appropriate equipment is being used to prevent, so far as is reasonably practical, any person falling a distance liable to cause injury?

  • MEWP

  • Scafolding

  • Is there evidence that scaffolding has been set up and being used correctly?

  • PASMA trained

  • Upper guard rail 95cm above working platform

  • Intermediate guard rail 47cm between toe board and upper guard rail

  • Access ladders extend 1m above landing point

  • No climbing on structure

  • Protected/secured to avoid unauthorised access

  • Weekly inspection completed

  • Are ladders being used?

  • Type of ladder:

  • Construction:

  • Photo of ladder

  • Has it been concluded that the work is low risk and short duration (less than 30 minutes)?

  • Is the ladder marked to indicate that it meets EN131 Professional (or if it met a previous standard is in good condition)?

  • Is the ladder marked to indicate that it is included on a register and subject to inspection?

  • Is the ladder free from oil/grease?

  • Are the rungs (steps) and stiles (outside uprights of ladder) free from damage?

  • Does the ladder have slip resistant feet?

  • Is there a suitable method of stabilising the ladder?

  • Tieing both stiles to the building at the top and bottom

  • Effective ladder stability device

  • Having a person foot the ladder (last resort)

  • Is the ladder stored properly when not in use?

Roof Work

  • Does the work require access to the roof of a block of flats?

  • Has a permit-to-access been authorised?


  • Hazard pictograms

  • Are substances with a CLP/CHIP warning symbol being used (resins, epoxy-based paints)?

  • Irritant (non-corrosive substance which can cause dermatitic or lung inflammation after repeated contact) e.g. glue, solvents (white spirit)

  • Corrosive - (destroy living tissue by burning it) e.g. acids

  • Harmful (if swallowed, inhaled or penetrates skin may pose risks) e.g. paints

  • Toxic (poisonous)

  • Carcinogenic (promote abnormal development of body cells) e.g. asbestos, hardwood dust

  • Are Safety Data Sheets available for hazardous substances?

  • Is a Safety Data sheet register maintained?

  • Does the operative have the correct COSHH assessments or COSHH summary sheets for items on site?

  • Are the controls on the COSHH assessments being applied?

  • Are chemicals correctly stored and separate as necessary?

Electrical Safety

  • Is work being carried out on circuits?

  • Have electrical isolations been made by our authorised electrical contractors using isolation kits?

  • Is the operative suitably trained and competent to carryout electrical work?

  • If mains voltage has to be used are RCD's with a tripping current not greater than 30ma available?

  • Have underground or hidden electrical cables been located (with a cable locator and cable plans), marked, and precautions taken?

  • If electrical cables/flexes are present are they free from damage and located in such a way as to avoid trip hazards?

Gas Safety

  • Is work being carried out on gas appliances?

  • Is the operative gas safe registered for domestic or commercial work where applicable?

  • Gas Safe Number
  • undefined

  • Is the operative carrying out work within their scope?

  • Install - permanently fixing, locating and connecting appliance to gas supply

  • Commission - operational checks immediately following installation of new appliance

  • Service - keeping appliance in working condition

  • Safety check - basic safety function and condition checks

Manual Handling

  • Has the operative been trained and informed of the outcomes of the manual handling assessment?

  • Has the operative received training on manual handling and safe lifting techniques?

  • Are mechanical aids/equipment (i.e. wheelbarrow/trolley) used so that manual lifting and handling of heavy objects is kept to a minimum?

  • Are materials (eg cement bags) ordered in sizes (max 25Kg) which can be lifted when on site?

  • Is there evidence of good manual handling techniques?

Fire Safety and Hot Works

  • Are flammable liquids stored properly?

  • Is a fire extinguisher available?

  • Has the operative been trained in the use of fire extinguishers?

  • Is hot work being carried out?

  • Is a permit to work in Place?

  • Has the area been cleared of combustible items?

  • Is a suitable fire extinguisher or extinguishing medium in place?

  • Has a 1 hour minimum fire watch been observed?

Violence at Work

  • Is a system in place to monitor the presence of lone, or out of hour’s workers?

  • Is the operative provided with information on persons held on Enfield Councils 'Cautionary Contacts Database?

General Workplace and Waste Management

  • Are work areas clearly and securely segregated?

  • Is the work area tidy and materials stored safely?

  • Is the area free from slip and trip hazards?

  • Are all unattended plant, ladders and equipment immobilised to prevent unauthorised use?

  • Are there suitable facilities for disposing of waste?

  • Is artificial lighting being used where required and is it safe?

Signature Page

  • Please enter name & sign

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.