Risk Assessment and Method Statement Checklist

• Site conducted

• Project Reference Number

• Property Location
  Address

• Conducted on

  Date

• Prepared by

• Brief description of the works (Internal, external, refurbishment, demolition etc.)

• Brief description of the site (Rural, urban, greenfield, occupied building etc.)

• Is there adequate natural or artificial light to carry out the task?

  Yes

  No

  N/A

• Is there a likelihood of Asbestos containing materials to be encountered during the works?

  Yes

  No

  N/A

• Is a Asbestos Register available for the property/project?

  Yes

  No

• Is there a likelihood of the tasks involved creating excessive dust/airborne contaminants?

  Yes

  No

  N/A

• Is there a likelihood of the tasks involved creating uncontrolled fumes?

  Yes

  No

  N/A

• Do the tasks involved require entry to a confined space?

  Yes

  No

  N/A

• Is there a likelihood of operatives coming into contact with sewage?

  Yes

  No

  N/A

• Are there any concerns regarding access to and from the proposed tasks?

  Yes

  No

  N/A

• Please confirm access concerns

  Select Interaction with pedestrians Interaction with vehicles Confined/restricted access Uneven terrain/slippery surfaces Interaction with building users Other (details in notes)

  • Interaction with pedestrians
  • Interaction with vehicles
  • Confined/restricted access
  • Uneven terrain/slippery surfaces
  • Interaction with building users
  • Other (details in notes)

• Are there any significant risks presented through the use of vehicles for the task?

  Yes

  No

  N/A

• Are there any significant risks presented through the interaction with vehicles for the task?

  Yes

  No

  N/A

• Is the use of heavy plant required for the tasks?

  Yes

  No

  N/A

• What types of heavy plant are required?

  Select Mini digger (0 - 6 metric tons) Midi digger (6 - 10 metric tons) Standard digger (10 - 90 metric tons) 1 ton dumper 3 ton dumper 6 ton dumper 9 ton dumper Fork lift truck Mobile crane Hi-ab/Lorry Loader Tower crane Other (details in notes)

  • Mini digger (0 - 6 metric tons)
  • Midi digger (6 - 10 metric tons)
  • Standard digger (10 - 90 metric tons)
  • 1 ton dumper
  • 3 ton dumper
  • 6 ton dumper
  • 9 ton dumper
  • Fork lift truck
  • Mobile crane
  • Hi-ab/Lorry Loader
  • Tower crane
  • Other (details in notes)

• What equipment/tools are required for the task?

  Select Hand Tools Power tools (Battery) Power tools (110v) Power tools (240v) Rotating cutting equipment (abrasive wheels) Vibrating tools e.g. floor scrapers, ragglers. Workshop machinery Other (details in notes)

  • Hand Tools
  • Power tools (Battery)
  • Power tools (110v)
  • Power tools (240v)
  • Rotating cutting equipment (abrasive wheels)
  • Vibrating tools e.g. floor scrapers, ragglers.
  • Workshop machinery
  • Other (details in notes)

• Are Hot Works required for the task

  Yes

  No

  N/A

• Will a Hot Works permit system be implemented?

  Yes

  No

• Is the task in close vicinity of a watercourse or body of water that presents significant risk?

  Yes

  No

  N/A

• Is there a requirement to work at height to complete the task?

  Yes

  No

  N/A

• What work at height equipment will be used to complete the task?

  Select Step ladders Ladders Fixed scaffold Tower scaffold Mobile Elevated Working Platforms (MEWP) Hop-up/Work platform Other (details in notes)

  • Step ladders
  • Ladders
  • Fixed scaffold
  • Tower scaffold
  • Mobile Elevated Working Platforms (MEWP)
  • Hop-up/Work platform
  • Other (details in notes)

• Are works to electrical circuits included in or required for the task?

  Select Yes No Unable to determine at time of audit

  • Yes
  • No
  • Unable to determine at time of audit

• Does the circuit have to remain live during the works?

  Select Yes No Unable to determine at time of audit

  • Yes
  • No
  • Unable to determine at time of audit

• Does the task involve or require works to High Voltage cables?

  Select Yes No Unable to determine at time of audit

  • Yes
  • No
  • Unable to determine at time of audit

• Are works to mechanical systems included or required for the task?

  Select Yes No Unable to determine at time of audit

  • Yes
  • No
  • Unable to determine at time of audit

• Is there a significant risk of Legionnaires posed by the works or as a result of the task being carried out?

  Select Yes No Unable to determine at time of audit

  • Yes
  • No
  • Unable to determine at time of audit

• Is any of the mechanical system to be worked with under excessive pressure?

  Select Yes No Unable to determine at time of audit

  • Yes
  • No
  • Unable to determine at time of audit

• Is any of the mechanical system subject to excessive heat?

  Select Yes No Unable to determine at time of audit

  • Yes
  • No
  • Unable to determine at time of audit

• Does the task include excavation work?

  Select Yes No Unable to determine at time of audit

  • Yes
  • No
  • Unable to determine at time of audit

• Has the equipment required been stated above?

  Yes

  No

• Confirm equipment required in heavy plant section

• Will the excavation be deeper than 800mm from Ground level?

  Select Yes No Unable to determine at time of audit

  • Yes
  • No
  • Unable to determine at time of audit

• Shuttering or battering back may be required. Confirm approach or seek further advice.

• Does the task include or require the use of any equipment included under COSHH provision (Substances Hazardous to Health).

  Select Yes No Unable to determine at time of audit

  • Yes
  • No
  • Unable to determine at time of audit

Method of works

• Please note any site specific methodology that is required to complete the task e.g. access prevents use of large vehicle, nature of works require minimum 2 person team etc.

• Please highlight all relevant risks identified

  Select Excavations Overhead cables Underground/buried services Lifting operations Manual Handling Use of hand tools Use of power tools Use of vehicles Use of heavy plant Work at height Work in the vicinity of water Traffic Interaction with the public Interaction with building/service users COSHH Open flames/Hot works Confined space/restricted access Asbestos Legionella Weil's disease Vibrations Dust Fumes Noise Environmental impact/waste management Other (details in notes)

  • Excavations
  • Overhead cables
  • Underground/buried services
  • Lifting operations
  • Manual Handling
  • Use of hand tools
  • Use of power tools
  • Use of vehicles
  • Use of heavy plant
  • Work at height
  • Work in the vicinity of water
  • Traffic
  • Interaction with the public
  • Interaction with building/service users
  • COSHH
  • Open flames/Hot works
  • Confined space/restricted access
  • Asbestos
  • Legionella
  • Weil's disease
  • Vibrations
  • Dust
  • Fumes
  • Noise
  • Environmental impact/waste management
  • Other (details in notes)

• Any other comments/observations.

Conclusion

• Supervisor/Manager

• Signature

  Sign

• Date

  Date