Information

  • Client Name

  • Address

  • Site Contact Name & Position

  • Contact Details

  • Conducted on

  • Prepared by

General

  • Describe task / role expected to be undertaken by on-Hired staff

  • Name & Contact of Person(s) supervising On-Hired staff

  • Will on-hired personnel be supervised at all times?

  • What type of training will be given?

  • Is there a person Trained in First Aid Onsite? (List name & Location)

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  • Is there a full / well stocked First Aid kit on site? (List location)

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  • Is there a First Aid register onsite to record injuries / illnesses? (List Location)

  • Is there a building evacuation plan that shows muster points on site?

  • Add media

  • Are all emergency exits clearly marked? (If Yes list how EG lights / floor markings)

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  • Are all emergency exits clear of obstructions and unlocked?

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  • Is there sufficient, risk appropriate fire fighting equipment onsite?

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  • Does all fire fighting equipment have clear access and correct signage?

  • Is all fire fighting equipment tested & tagged regularly (Within the last 6 month)? (List last tag date)

  • Are the toilets clean & well stocked with toilet paper & soap?

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  • Is there a safe location staff & store personal belongings? (EG Lockers / Behind Desk - please list)

  • Is there access to clean drinking water?

  • Is there a dedicated lunchroom or area where staff can take breaks? (List Location)

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  • Are there facilities for storing / heating food On-Hired staff can use? (EG Fridge / Microwave - Please List)

  • Is the site free from chemicals? (Other than household cleaners - If no please list type(s) & location of MSDS)

Manual Handling & Environment

  • Describe or picture work area / environment

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  • Is there sufficient lighting onsite for On-Hired staff to undertake duties required?

  • Is the work environment temperature comfortable to undertake duties in? (Not overly hot or cold)

  • Is work area clear of slip / trip / fall hazards? (EG Cords / boxes / uneven surfaces)

  • Will maximum manual handled weight exceed 15kg for a female or 25kg for a male on this role? (If yes please list weight & steps put in place to minimize risk below)

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  • Are loads moved over a short distance only? (Less than 15 metres)

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  • Are items handled of regular size, shape and easy to get a grip on? (If no please list & / or photo where possible)

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  • Are mechanical aids available to On-Hired staff which would minimise manual handling? (Eg Trolley / Pallet Jacks / Rollers - If Yes please list type)

  • Add media

PPE - Notes - Signature

  • Is PPE required for this role? (Please list)

  • Please list: Risks Identified (If any) / Recommendations / Notes

  • Company Client Representative or Site Contact Signature:

  • Person Whom Completed Workplace Safety Assessment:

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.