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  • Conducted on

  • Location
  • Prepared by

  • Personnel on Site

Does your work involve any of the following Safe Work Method Statements (SWMS)?

  • Confined Spaces Entry

  • Complete HS-FRM-006 Confined Spaces Entry Permit

  • Is isolation (lockout/tagout) required?

  • Complete HS-FRM-021 Electrical Hazard Preventative Actions Checklist

  • Trenching and Excavation

  • Complete HS-FRM-003 Permit To Excavate

  • Working Near Live Services

  • Complete HS-FRM-011 Overhead Wire Assessment and Dial Before You Dig plans are on site and understood

  • Working at Heights Greater than 2m

  • Complete Working At Heights Permit Ect

  • Movement of Powered Mobile Plant

  • Complete Vehicle movement Plan

  • Working On or Adjacent to Roads

  • Ensure Traffic Management Plan is in place Ect

  • Demolition

  • Complete HS-FRM-018 Demolition Safety Checklist

  • Working On or Adjacent to Rail

  • Ensure rail permit is completed and adhered to

  • Working In, Over ar Adjacent to Water

  • Complete HS-FRM-013 Working In, On, Over or Adjacent to Water Checklist

  • Non Friable Asbestos Removal

  • Complete HS-FRM-020 - Asbestos Removal Control Plan Template

  • Working Near Energised Electrical Installations

  • Complete HS-FRM-021 Electrical Hazard Preventative Actions Checklist

Are any of the following supplementary safety requirements needed?

  • Is work being conducted near Overhead Powerlines/Communications assets?

  • Complete HS-FRM-011 Overhead Wire Assessment

  • Hot Work Permit

  • Complete HS-FRM-024 Hot Work Permit

  • Lifting Operations by Mechanical Means

  • Complete HS-FRM-014 Lifting Operations Checklist

Site Specific Photos

  • Photos of site

  • Task Supervisor

  • Team Member

  • Complete JSEA

  • Complete JSEA

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.