Risk Assessment - Site Specific

Job And Location details

• Date

• Job number

• Site Supervisor

• Location of nearest welfare facilities

• Nearest A+E Hospital

Stage 1

• Is a copy of the task RAMS available on site and has it been briefed to all those involved? (If ‘no’ you cannot continue)

  Yes

  No

  N/A

Stage 2

• Is the person completing this form competent in the completion of risk assessments? (If ‘no’ you cannot continue).

  Yes

  No

  N/A

Stage 3 – Does the work involve interaction with any of the following (if ‘yes’, this you must stop work and consult your Supervisor before progressing)?

• HV Cables / Substation

  Yes

  No

  N/A

• High Public Amenity Area

  Yes

  No

  N/A

• Pedestrian Crossing

  Yes

  No

  N/A

• O/H Lines

  Yes

  No

  N/A

• Emergency Services Access

  Yes

  No

  N/A

• On or near Rails

  Yes

  No

  N/A

• HP or IP Gas

  Yes

  No

  N/A

• Bridge / Culvert

  Yes

  No

  N/A

• Bus Stop

  Yes

  No

  N/A

• Fuel/Oil Pipelines

  Yes

  No

  N/A

• Lone Working

  Yes

  No

  N/A

• School/play area

  Yes

  No

  N/A

• Trunk Mains

  Yes

  No

  N/A

• Busy Traffic Junction

  Yes

  No

  N/A

• Telephone exchange

  Yes

  No

  N/A

• Hi-Speed Road (40+ Mph)

  Yes

  No

  N/A

• Work at Night

  Yes

  No

  N/A

• 3rd Party Sites

  Yes

  No

  N/A

• Poor / Uneven Ground

  Yes

  No

  N/A

• Restricted Access

  Yes

  No

  N/A

• Excavations requiring shoring

  Yes

  No

  N/A

• Adverse Weather

  Yes

  No

  N/A

• Height Work/Ladders/MEWPS

  Yes

  No

  N/A

• Contaminated Ground

  Yes

  No

  N/A

• Adjacent to Water

  Yes

  No

  N/A

• Deliveries – Moving Vehicles

  Yes

  No

  N/A

• Lifting Operations

  Yes

  No

  N/A

• Protected Species/Site/Tree

  Yes

  No

  N/A

• Monuments / Structures

  Yes

  No

  N/A

• Invasive Species i.e Knotweed

  Yes

  No

  N/A

• Asbestos

  Yes

  No

  N/A

• Confined Spaces

  Yes

  No

  N/A

• Other:

Competency holders

• (i.e. Steetworks, MEWP, Confined Space, Cat and Genny)

• Competency

• Name

• Competency

• Name

• Competency

• Name

• Competency

• Name

PPE Required

• (Tick)

• Head Protection HELMET

• food protection BOOTS

• high- visibility VEST

• Hand Protection GOLVES

• Eye Protection GLASSES

• Hearing Protection EAR MUFFS

• PROTECTIVE COVERALL

• Respiratory Protection RESPIRATOR

Stage 5 – Identify key task hazards and the control measures to be used that are not suitably covered by the RAMS that has been produced for the task, particularly those not identified in section 3:

• Hazard

• Control Measure

• Hazard

• Control Measure

• Hazard

• Control Measure

• Hazard

• Control Measure

• Hazard

• Control Measure

Stage 6 - Communication

• I/we confirm that the contents of this Risk Assessment have been explained to me/us and I/we agree to abide by the control measures and inform the site supervisor immediately of any changes that may affect the health and safety of me/us or others likely to be affected by the works. We have the correct competencies, permits, equipment, and PPE to carry out the work safely.

• Sign

  Sign

• Print

  Drawing

Stage 7 – Pre-start checks

• Do adequate advance warning signs exist and are they secured?

  Yes

  No

  N/A

• Is the work zone and safety zone barriered off correctly?

  Yes

  No

  N/A

• If a safe pedestrian walkway is required is it established and the correct width?

  Yes

  No

  N/A

• Are kerb ramps / walk boards in place where necessary and are they secured?

  Yes

  No

  N/A

• Are road plates required, and if so are they in place and secured?

  Yes

  No

  N/A

• Are courtesy boards in place, readable and attached correctly?

  Yes

  No

  N/A

• Are pedestrian arrows required and attached correctly?

  Yes

  No

  N/A

• Are all S&G uprights supported by bases / feet?

  Yes

  No

  N/A

• Is all the equipment fit for purpose?

  Yes

  No

  N/A

• If footway is to be closed is an agreement in place and logged and are the correct

  Yes

  No

  N/A

• signs being used?

  Yes

  No

  N/A

• Signed by the person completing this form who is responsible for the safe set up of the site (must be signed before work starts and check made that all are signed to the RAMS and a copy is present with the team)

  Sign

• IF CIRCUMSTANCES ON SITE CHANGE, WORKS MUST STOP AND THE RISKS MUST BE RE-ASSESSED