Title Page
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Site conducted
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Prepared by
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Other persons working on task
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Date
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Description of work
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Location
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Are you fit to work today?
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Please contact your supervisor before conducting any work.
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Do you have approval to perform your task?
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Please contact your supervisor before conducting any work.
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Do you have the correct tools, equipment and PPE? Are they in good condition and within test dates?
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Please contact your supervisor before conducting any work.
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Are there any new hazards on site today?
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Referring to the risk matrix what is the risk score before hazard control measures?
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What control measures are put in place?
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Referring to the risk matrix what is the risk score AFTER hazard control measures?
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Do not proceed with this task, more hazard control is required.
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Supervisor Signature Required.
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Proceed with caution.
Sign Off
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Confirm that the work is safe to undertake and that all practicable steps have been taken to reduce risks.
If there are outstanding hazards, contact your supervisor/manager. -
Employee Signature
