Title Page
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Site conducted
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Conducted on
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Description of the Task/Activity
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Project Name:
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Project Ref:
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Site Address/Location
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Project Start Date
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Project End Date
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Personnel Involved:
Person
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Name and Surname
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Role/Trade
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Works Supervisor:
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Role:
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Contact Number:
Key Plant and Tools Required:
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Key Materials Required:
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Other Essential Equipment:
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Specific Identified Residual Hazards:
Specific Staff Training Requirements:
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Sequence of Operations:
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Temporary Supports and Props needed to facilitate the works:
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Method of Access and Egress to the work area:
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Fall Protection Measures:
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Required Personnel Protective Equipment:
- Gloves
- Foot (Boots)
- Eye protection
- Protective Hearing Devices (earplugs, muffs)
- Hard Hats
- Respirators
- Full Body Suits
- Full Body Climbing Harness
- Masks or Shields
- Other
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Please specify
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Emergency Procedures:
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Name of on-site First Aider:
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First Aid Box Location:
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Nearest Hospital:
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Other Information & Comments, Ex: 1. All workers are responsible for taking care of their PPE. 2. Whenever possible use mechanical lifting equipment and keep manual handling to a minimum. 3. Ensure all tools are inspected upon use.
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Prepared by
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Designation
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Select date
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Reviewed by
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Designation
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Select date
