Site Risk Assessment - Test Version

Stage 1: Site Specific Data

• Document No.

• Date

  Date

• Job number / Client Site

• Provide geolocation
  Address

• Site Supervisor / Line Manager

• Name of Risk Assessor:

• Others (operatives/ visitors) covered in this risk assessment:

• Location of Nearest Welfare Facilities

• Nearest A + E Hospital

Stage 2: Type of Work

• Does your job acitivity involve Cable Pulling and Roping?

  Yes

  No

  N/A

• Does your job activity involve Underground Work?<br>

  Yes

  No

  N/A

• Does your job activity involve Working at Height?

  Yes

  No

  N/A

• Does your job activity include working at SDU/MDUs

  Yes

  No

  N/A

• Other - Please specify

Stage 3: Who is at Risk?

• Contractor / Employee

  Yes

  No

  N/A

• Operative Third-Parties

  Yes

  No

  N/A

• Members of the Public

  Yes

  No

  N/A

• Visitors

  Yes

  No

  N/A

• Children / Vulnerable Person

  Yes

  No

  N/A

Stage 4: Documentation

• Is a copy of the RAMS for the task available on-site?

  Yes

  No

  N/A

• Have the RAMS been briefed to all those involved? If no, you cannot continue.

  Yes

  No

  N/A

Stage 5: Pre-Start Checks

• Is there adequate lighting on site whilst operatives are working?

  Yes

  No

  N/A

• Does the team have all the required PPE to complete the job safely? <br>

  Yes

  No

  N/A

• Are all operatives trained and experienced to carry out the job?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are all relevant tools and equipment available on site?

  Yes

  No

  N/A

• Are the tools and equipment suitable and safe for the intended use? <br>

  Yes

  No

  N/A

• Is the site set up according to the New Roads and Street Works Act 1991 (Red Book)

  Yes

  No

  N/A

Stage 6: Does the work involve interaction with any of the following (if "yes", you must stop work and consult your supervisor before progressing)

• Adverse Weather

  Yes

  No

  N/A

• Contaminated Under/-Ground

  Yes

  No

  N/A

• Asbestos

  Yes

  No

  N/A

• High Speed Road (+40 MpH)

  Yes

  No

  N/A

• Busy Traffic Junction

  Yes

  No

  N/A

• High Public Amenity Area

  Yes

  No

  N/A

• Pedestrian Crossing

  Yes

  No

  N/A

• School / Play Area

  Yes

  No

  N/A

• 3d Parties on site

  Yes

  No

  N/A

• Deliveries - Moving Vehicles

  Yes

  No

  N/A

• Poor / Uneven Ground

  Yes

  No

  N/A

• Deliveries - Moving Vehicles

  Yes

  No

  N/A

• Elictrical Live Cables

  Yes

  No

  N/A

• Lifting and Manual Handling Operations

  Yes

  No

  N/A

• Confined Spaces

  Yes

  No

  N/A

• Hazardous Substances

  Yes

  No

  N/A

• Hand-Arm Vibration

  Yes

  No

  N/A

• Loud Noise

  Yes

  No

  N/A

• Lone Working

  Yes

  No

  N/A

• Work-Related Violence

  Yes

  No

  N/A

Stage 7: Hazard Identification . Identify the key task hazards and control measures that the RAMS do not suitably cover, particularly those not identified in Section 6.

Hazard 1 and Control Measure 1

• Hazard 1

• Control Measure 1

Hazard 2 and Control Measure 2

• Hazard 2

• Control Measure 2

Hazard 3 and Control Measure 3

• Hazard 3

  Yes

  No

  N/A

• Control Measure 2

  Yes

  No

  N/A

Stage 8: Risk Rating . Evaluate the risks

• Low Risk

  Yes

  No

  N/A

• Medium Risk

  Yes

  No

  N/A

• High Risk

  Yes

  No

  N/A

Stage 9: Declaration

• I/we confirm that the contents of this Risk Assessment have been explained to me/us and I/we agree to abide by the control measures and inform the site supervisor immediately of any changes that may affect the health and safety of me/us or others likely to be affected by the works. We have the correct competencies, permits, equipment, and PPE to carry out the work safely.

• Printed Name

• Signature

  Sign

• Printed Name

• Signature

  Sign

• Printed Name

  Sign

• Signature

  Yes

  No

  N/A

• IF CIRCUMSTANCES ON SITE CHANGE, WORKS MUST STOP AND THE RISKS MUST BE RE-ASSESSED

• Date and time of approval

  Date

• Approver's signature

  Sign