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)
Electrical, Ergonomics & 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 / Controlled (Air conditioned) to undertake duties in? (Not overly hot or cold)
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Is the work station (Desk) at a good height and has an height adjustable chair to be able to perform work duties in a correct posture?
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Is the adjustable chair clean & in good working order? (EG Height adjustable lever working, Wheels / rollers working and in good order ETC)
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Is there sufficient leg room under the desk?
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Is the work environment free from Trip, slip hazards or uneven surfaces?
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Are all plug sockets / switches and leads in good condition? (IE: Not damaged, Frayed or exposed wires showing)
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Is electrical equipment / leads etc tested and tagged? (If yes please list tag date)
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Are all electrical leads and wires organized in a neat and orderly fashion as to eliminate tripping hazards?
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Manual Handling - Other - Notes - Signature
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Will on-hired staff AVOID lifting heavy / bulky or awkward items? (Heavy = What a person is capable of OR no more that 5kg from a seated position / 15kg from other positions)
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Are most commonly used items easily accessible and stored between shoulder and mid thigh level?
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If High shelving needs to be accessed is there appropriate equipment available for accessing those shelves? (EG Safety steps)
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Is there a requirement for on-hired staff to work in isolation or remotely from other staff or workforce? (If YES please list below measures put in place for communication / Safety ETC)
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Apart from general cleaning products are there any other chemicals stored onsite? (EG paint thinners / metholated spirits)
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If yes are those chemicals stored in there correct containers & are the MSDS / SDS readily available for those chemicals. (List location of MSDS)
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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: