Page 1: Project Details

  • Project Name & ID

  • Site Location
  • Delivery Manager & Contact Details

  • Lead Engineer/Supervisor & Contact Details

  • Start Date For Predicted Works

  • Projected Works End Date

Page 2: Information & Compliance

General Building Information

  • Number of Floors

  • Number of exits (for emergencies)

  • Access to work areas

  • Confirm method of entry - Inclusive of door access codes

  • Please confirm access with Delivery Manager ahead of attending the site

  • No access arrangements required

Site Arrangements

  • Site Contact & Number

  • Out of Hours Contact Number

  • Welfare

  • Parking

  • Storage

Scope Of Works

  • undefined

Regulatory Compliance

  • Health & Safety at Work Act 1974
    Management At Work Regulations 1999
    Duty Roll of Contractor Under CDM 2015
    Working At Height Regulations 2005
    Manual Handling Regulations 1992
    PUWER Regulations 1998
    Wiring Regulation 1998
    Control Of Asbestos Regulations 2012
    COSHH Regulations 2002
    Control Of Noise At Work Regulations 2005
    Control Of Vibrations AT Work Regulations 2005

Fire Stopping

  • Please ensure all firestopping is undertaken using the appropriate installation method for the product type(s) being applied at the point of installation.

Protection Of Others

  • It has been noted that the site is a fully occupied development and as such the protection and safety of others is paramount.
    The working environment will be managed in a safe and appropriate manor. With all tooling, equipment and plant secured in safe working areas and attended by the operative or stored in authorised access areas.

  • It has been noted that the site is not currently occupied, access and egress of the property should be reported to line management.
    The working environment will be managed in a safe and appropriate manor. With all tooling, equipment and plant secured in safe working areas and attended by the operative or stored in authorised access areas.

Training

  • Voltwave commit to ensuring that all personnel undertaking works are competent in the relevant tasks and complete the following training courses as a mandatory requirement within their role:
    General Site Safety
    PPE Requirements
    Working at Height (safe use of stepladders)
    Manual Handling
    Asbestos Awareness

Page 3: Risk Assessment

Site Hazards

  • Access & Egress
    Slips, Trips & Falls
    Vehicle Movements
    Working At Height
    Manual Handling
    Falling Debris
    Drilling/Digging ActivitiesStructural Instability

  • State Other Hazards Specific To Site

PPE Requirements

  • Hi-Visibility Waistcoat EN471
    Safety Boots EN20345
    Hard Hat EN397
    Safety Glasses EN166
    Ear Protection EN352
    Gloves EN388
    Dust Mask EN149

  • State Other PPE Requirements Specific To Site

Plant and Access Requirements

  • Confirm Plant & Access Equipment

  • State Plant or Equipment Requirements Specific To Site

Third Party Works

  • Confirm all 3rd Party Works

Emergency Procesures

  • First Aid Procedures:
    All onsite personnel will be notified of the first aiders available and will have access to a first aid kit for administering treatment to minor injuries.

  • First Aider & Contact Details (If Applicable)

  • Location of Nearest Hospital

  • Fire Evacuation Procedures:
    All onsite personnel will familiarise themselves with the Fire Evacuation procedure and Fire Assembly Points.

  • Location of Fire Assembly Point

Page 4: Risk Assessment Scoring

Access & Egress

  • Likelihood X Severity indicates the possible level of risk prior to implementing any reasonable control measures
    -Low Risk 1-3
    -Moderate Risk 4-6
    -High Risk 8-12
    -Extremely High Risk 13-25
    The residual risk level represents the actual level of risk as a result of control measures being imlemented

  • Persons Affected

  • Likelihood

  • Severity

  • Risk Level

  • Control Measures
    -Segregation of working areas
    -Correct use of signage & barriers
    -Ensure safe walking routes
    -Keep routes clean & tidy with adequate lighting

  • Residual Risk

Slips Trips & Falls

  • Persons Affected

  • Likelihood

  • Severity

  • Risk Level

  • Control Measures
    -Good levels of housekeeping in the working areas
    -All walkways left clear of tooling & equipment
    -No trailing cables to be left un-attended in public areas
    -Non slip safety footwear to be worn at all times

  • Residual Risk

Vehicle Movements

  • Persons Affected

  • Likelihood

  • Severity

  • Risk Level

  • Control Measures
    -Hi-Visability clothing to be worn at all times in high traffic areas
    -Adequate barrier protection to be used for segregation ensuring 1.5m space to allow safe pedestrian access
    -Signage denoting work activity to be displayed
    -Ensure working area is well lit

  • Residual Risk

Working at Height

  • Persons Affected

  • Likelihood

  • Severity

  • Risk Level

  • Control Measures
    -Operatives using WAH access equipment are trained & competent
    -Working at height activity will be conducted in a safe place
    -Segregation of working at height with berrier or banksman
    -User inspections of WAH access equipment prior to use

  • Residual Risk

Manual Handling

  • Persons Affected

  • Likelihood

  • Severity

  • Risk Level

  • Control Measures
    -Operatives trained in Manual Handling Regulations
    -Use of mechanical aids to be used where reasonable practicable
    -Two person lifting operations specific to the task
    -Walkway and access areas to be assessed for clearance

  • Residual Risk

Falling Debris

  • Persons Affected

  • Likelihood

  • Severity

  • Risk Level

  • Control Measures
    -Segregation of working areas
    -Correct use of signage & barriers
    -Ensure safe walking routes
    -Keep routes clean & tidy with adequate lighting
    -Correct PPE being worn at all times
    -Use of safety nets or similar protective measures where feasible


  • Residual Risk

Structural Instability

  • Persons Affected

  • Likelihood

  • Severity

  • Risk Level

  • Control Measures
    -Segregation of working areas
    -Correct use of signage & barriers
    -Ensure safe walking routes
    -Keep routes clean & tidy with adequate lighting
    -Correct PPE being worn at all times
    -Use of temporary supports


  • Residual Risk

Hidden Services

  • Persons Affected

  • Likelihood

  • Severity

  • Risk Level

  • Control Measures
    -Correct PPE being worn at all times
    -Use of stud finder to locate and existing wiring/services
    -Isolate power to working area
    -Isolate gas / water supply to working area
    -Consult building plans where available

  • Residual Risk

Dust and Noise

  • Persons Affected

  • Likelihood

  • Severity

  • Risk Level

  • Control Measures
    -Correct PPE being worn at all times
    -Keep windows and doors closed to contain dust and noise
    -Use of water mist to contain dust particles
    -Use of suction device to contain dust particles

  • Residual Risk

Drilling/Digging Activity

  • Persons Affected

  • Likelihood

  • Severity

  • Risk Level

  • Control Measures
    -Inspection of working area to check for other services
    -Use of the required items of PPE
    -Correct drilling/digging techniques
    -Segregation from public areas prior to drilling/digging
    -Area reinstated in a safe and compliant manner
    -Permits in place and displayed (if required)

  • Residual Risk

Page 5: Method Statement

  • Safe Working Method

Work Flow

  • -Report to site contact, sign in and complete and applicable induction/toolbox talk
    -Obtain permission to work
    -Review risk assessments and safe working procedures
    -Select the appropriate PPE and ensure it is fit for use
    -Carry out all works specified within the agreed scope of works and in accordance with all training and instructions
    -Work in public areas are to have correct signage displayed and barriers installed
    -Continue to review and risks throughout the installation for possible changes
    -Complete documentation and report on all works carried out highlighting and significant changes
    -Sign out of working area daily with site contact.

Page 6: Report Acceptance/Sign Off

Management

  • Voltwave Director

Field Team

  • Supervisor/Team Lead

  • Operative

  • operative

  • operative

  • operative

  • operative

  • operative

  • operative

  • operative

  • Add signature

Site Visitors

  • Site Visitor

  • Site Visitor

  • Site Visitor

  • Add signature

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.