Title Page
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Job Number
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Location
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Job Description
Prestart Checklist - General
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Is applicable maintenance completed? (If no - add a note with additional details)
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Are there dangerous animals onsite?
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Is a Lock Box Required? (If Yes - add a note with code & location)
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Does insured want Private Works? (If Yes - add a note with what Private Works are required)
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Is Temporary Accommodation Required? (If Yes - add a note with duration of accommodation)
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Is any Hire Equipment Required? (If Yes - add a note with what equipment)
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General Comments:
General Site Hazards
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Is there Clear Access to site?
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Is the Site Occupied?
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Is there Overhead Electrical Services or Underground Services?
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If Overhead Electrical Services - Is an ESA Required?
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If Other - What Services are available?
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Will there be any Demolition Works? (If Yes - This may require a SWMS)
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Will there be Confined Spaces Works? (If Yes - This will require a SWMS)
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Is there a Fall from Heights Risk? (If Yes - This will require a SWMS)
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Is this property in a Remote Location?
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Is there any Lighting Issues?
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General Comments:
Health Site Hazards
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Will there be contact with Chemicals, including Flammable Gases/Fumes? (If Yes - this will require a SWMS)
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Will there be contact with Asbestos? (If Yes - This will require a SWMS)
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Will there be contact with Silica or Exposure to Silica Dust? (If Yes - This will require a SWMS)
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Is there Mould/Fungi onsite?
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Is there any Specific PPE Required?
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If Yes - List what items required
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Is there a First Aid Kit onsite?
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General Comments:
Risk Assessment Tasks (Low Risk Tasks Only - High Risk Tasks must have a SWMS)
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This Risk Matrix is to be used to determine risk rating prior to control measures and again after control measures are applied. Any rating of "High Risk" is unacceptable and requires further control measures applied.
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NOTE: Any tasks that are considered HIGH RISK must have a SWMS completed
Job Task
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Activity / Task
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If Other - Describe the Activity / Task
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Potential Hazards & Risks
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If Other - List Potential Hazards & Risks
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Risk Rating
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Control Measures
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If Other - List additional Control Measures
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Residual Risk Rating
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Person Responsible
Supervisor Signature
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Supervisor Name & Signature
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Date Prepared