Title Page
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Audit Title
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W/O Number
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Client
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Location
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Job Description
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Date
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Site Contact Name
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Site Contact Number
Process
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Establish Safe Worksite.
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Are there any Hazards?
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What are the Hazards?
- Fall from heights
- Electrocution
- Cuts
- Falling objects
- Eye injury
- Dust
- Noise
- Weather
- Moving parts
- Crush injury
- Foot injury
- Fire
- People
- Transport
- Slipping/Tripping
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What are the Controls?
- Safety glasses/facesheild
- Steel capped non-slip boots
- Hard hats
- Safety harness
- Earmuffs/plugs
- Dust mask
- Leather gloves
- Safety observer
- Lock out/tagout
- Barriers/cones
- Overalls
- Fire extinguisher
- Ladder secured top and bottom
- House Keeping
- High Viz Clothing
- Delay job
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Step 2.
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Step Description.
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Are there any Hazards?
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What are the Hazards?
- Fall from heights
- Electrocution
- Cuts
- Falling objects
- Eye injury
- Dust
- Noise
- Weather
- Moving parts
- Crush injury
- Foot injury
- Fire
- People
- Transport
- Slipping/Tripping
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What are the Controls?
- Safety glasses/facesheild
- Steel capped non-slip boots
- Hard hats
- Safety harness
- Earmuffs/plugs
- Dust mask
- Leather gloves
- Safety observer
- Lock out/tagout
- Barriers/cones
- Overalls
- Fire extinguisher
- Ladder secured top and bottom
- House Keeping
- High Viz Clothing
- Delay job
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Step 3
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Step Description.
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Are there any Hazards?
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What are the Hazards?
- Fall from heights
- Electrocution
- Cuts
- Falling objects
- Eye injury
- Dust
- Noise
- Weather
- Moving parts
- Crush injury
- Foot injury
- Fire
- People
- Transport
- Slipping/Tripping
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What are the Controls?
- Safety glasses/facesheild
- Steel capped non-slip boots
- Hard hats
- Safety harness
- Earmuffs/plugs
- Dust mask
- Leather gloves
- Safety observer
- Lock out/tagout
- Barriers/cones
- Overalls
- Fire extinguisher
- Ladder secured top and bottom
- House Keeping
- High Viz Clothing
- Delay job
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Is there another step?
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Step 4.
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Step Description.
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Are there any Hazards?
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What are the Hazards?
- Fall from heights
- Electrocution
- Cuts
- Falling objects
- Eye injury
- Dust
- Noise
- Weather
- Moving parts
- Crush injury
- Foot injury
- Fire
- People
- Transport
- Slipping/Tripping
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What are the Controls?
- Safety glasses/facesheild
- Steel capped non-slip boots
- Hard hats
- Safety harness
- Earmuffs/plugs
- Dust mask
- Leather gloves
- Safety observer
- Lock out/tagout
- Barriers/cones
- Overalls
- Fire extinguisher
- Ladder secured top and bottom
- House Keeping
- High Viz Clothing
- Delay job
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Is there another step?
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Step 5.
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Are there any Hazards?
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What are the Hazards?
- Fall from heights
- Electrocution
- Cuts
- Falling objects
- Eye injury
- Dust
- Noise
- Weather
- Moving parts
- Crush injury
- Foot injury
- Fire
- People
- Transport
- Slipping/Tripping
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What are the Controls?
- Safety glasses/facesheild
- Steel capped non-slip boots
- Hard hats
- Safety harness
- Earmuffs/plugs
- Dust mask
- Leather gloves
- Safety observer
- Lock out/tagout
- Barriers/cones
- Overalls
- Fire extinguisher
- Ladder secured top and bottom
- House Keeping
- High Viz Clothing
- Delay job
Unlisted Hazards
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Are there any other Hazards NOT listed above?
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What are these Hazards?
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What are the Controls?
Tru-Bilt Risk Matrix Level
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What is the Tru-Bilt Risk Matrix Level before Controls are in place?
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What is the Tru-Bilt Risk Matrix Level after Controls are in place?
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Job can Proceed.
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Job can Proceed.
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Job can Proceed with CAUTION.
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Job CANNOT PROCEED until Risk Matrix Level is reduced.
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Can something be done to reduce Risk Matrix Level?
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What has to be done?
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Has the Risk Matrix Level been reduced?
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Job can proceed.
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Job CANNOT PROCEED!
Extra Information/Sign off
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Do any of these situations apply?
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Has Department of Labour been Contacted? 0800 20 90 20
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*Work where workers could fall 5 m or more, excluding work on a two-storeyed house, or work on a power or telephone line, or work carried out from a ladder only, or maintenance or repair work of a minor or routine nature.
*The erection or dismantling of scaffolds from which a person could fall 5 m or more.
*Every excavation which is more than 1.5 m deep and which is deeper than it is wide at the top.
*Any form of tunnel or drive where workers work underground, irrespective of timbering or support.
*Those excavations where the excavated face is steeper than 1 horizontal to 2 vertical.
*Any construction work where explosives are used or stored.
*Work such as diving, where construction workers breath air or any other gas that has been compressed or is under pressure.
*Any construction work in connection with asbestos fibres.
*Lifts of half a tonne (500 kg) or more (a vertical distance of 5 m or more) carried out by mechanical means other than by a mobile crane, excavator or forklift. -
Emergency Plan.
Raise Alarm, Call for Help, Perform Self Rescue, Call or Phone for help, Perform Assisted Rescue, Perform First Aid, Call Emergency Services. -
Workers Names.
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Have ALL workers signed in?
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Why not?
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What tools/equipment are going to be being used?
- Hammer Drill
- Impact Driver
- Drill
- Grinder
- Welder
- Hand Tools
- Scissor Lift
- Fork Lift
- Ladder
- Gib Lift
- Harness/Fall Arrest System
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Has Training Matrix been checked to insure all workers are competent with tools/equipment being used?
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Pictures
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Notes on job.
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Performed by.
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Signature
