Title Page
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OPP/VPT Number
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Client / Site
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Conducted on
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Location
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Personnel
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Identify work activity below and Select the applicable risk level. Work activities that are selected High or Extreme must have a safe work method statement attached with detail of control measures to be implemented. All work activities classified Medium must detail control measures to be implemented to reduce risk.
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Working in ceiling space
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Portable ladder use
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Working at heights above 1.5m
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Elevated work platform / Scissor lift use
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Install / Service ceiling mounted projector
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Build / Service rack
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Working in building risers
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Cabling installation
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Heavy lifting including mounting screens.
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Terminate cabling / Optical fibre
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Hazardous substance use
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Electronic repairs
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Power tool use
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Hand tool use
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Noise exposure
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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Dust / Debris Exposure
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What level of risk?
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Can control measures be put in place to reduce the risk to low?
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Describe the control measures
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Stop work and assess Safe work method statements to assess further controls. Work shall not commence or proceed where it is considered by an individual that safe working practices are unable to be applied.
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