Information
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Client Name
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Address
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Site Contact Name & Position
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Contact Details
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Conducted on
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Prepared by
General
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Describe task / role expected to be undertaken by on-Hired staff
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Name & Contact of Person(s) supervising On-Hired staff
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Will on-hired personnel be supervised at all times?
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What type of training will be given?
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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)
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Is there a building evacuation plan that shows muster points on site?
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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?
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Is all fire fighting equipment tested & tagged regularly (Within the last 6 month)? (List last tag date)
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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)
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Is there access to clean drinking water?
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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)
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Is the site free from chemicals? (Other than household cleaners - If no please list type(s) & location of MSDS)
Manual Handling & Environment
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Describe or picture work area / environment
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Is there sufficient lighting onsite for On-Hired staff to undertake duties required?
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Is the work environment temperature comfortable to undertake duties in? (Not overly hot or cold)
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Is work area clear of slip / trip / fall hazards? (EG Cords / boxes / uneven surfaces)
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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)
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PPE - Notes - Signature
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Is PPE required for this role? (Please list)
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Please list: Risks Identified (If any) / Recommendations / Notes
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Company Client Representative or Site Contact Signature:
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Person Whom Completed Workplace Safety Assessment: