Title Page

  • Client

  • Site Address:
  • Date

  • Prepared by

  • Personnel

Assessment of Tasks

Tasks Associated

  • What tasks are associated with the work involved?

  • Other

Authorisation

  • The authorisation of this site specific risk assessment is an acknowledgement of Jim's Test & Tag's commitment to all aspects of work/occupational health and safety and is authorised by:

  • This is to verify that having conducted works in accordance with the SWMS indicated above, the controls have been found to provide adequate protection and that no other safety issues have been identified. If the controls have been found to be inadequate the Divisional Franchisors are to be notified via the feedback form on the Intranet. If a high risk has been identified, the Divisional Franchisors are to be contacted immediately.

  • Additional controls required?

  • Client signature to acknowledge receipt of this site specific risk assessment

Assessment of risk

  • Are Risks are associated with the tasks involved?

  • Site set up?

  • Traffic Management Specialist required?

  • Excavation?

  • Jointing Chamber Excavation/Building?

  • Core Drill?

  • Excavation Near trees?

  • Working near Railways (within 200meters of level crossing)?

  • Moleplough of duct (survey to be completed seperatley)

  • Reinstatement?

  • Use of Hand Tools?

  • Use Of Machinery?

Control of Risks associated with tasks?

  • Site Set Up

  • Traffic Management Specialist required

  • Excavation

  • Jointing Chamber Excavation/Building/Installation

  • Core Drilling

  • Excavation near trees

  • Working Near Railways.

  • Use of Hand tools

  • Use Of Machinery

  • Reinstatement

POWRA

  • A point of work risk assessment will be carried out daily or at each phase of work

other information

  • see attached other documentation

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.