Title Page
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Site conducted
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It is important that all the persons working or visiting the site are provided with all necessary information/riles/method statements/risk assessments that may affect them and/or is required to ensure they can carry out their work safely. The person in charge of the site must carry outa site specific safety briefing to all persons working on/visiting the site.
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Conducted on
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Conducted by
- Adam
- Ryan
- Alex
- Jamie
- Lee
- Sully
- Leo
- Jack
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Location
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Area
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Site address
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Brief description of works
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Persons likely to be affected by your activities
- Staff & Contractors
- Visitors
- Public and Motorists
- Other
Hazards - are these hazards present?
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Use the residual risk rating guide to answer the following questions
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Protection of works / pedestrians & vehicles (Red Book)
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Residual risk rating
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Detail site observation/site specific control measures/general comments
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Underground / overhead apparatus
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Residual risk rating
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Detail site observation/site specific control measures/general comments
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Excavation(s) (ground conditions, positioning of spoil etc)
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Residual risk rating
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Detail site observation/site specific control measures/general comments
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Work location (sub-station, schools, level crossing, shops and pedestrian crossing etc)
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Residual risk rating
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Detail site observation/site specific control measures/general comments
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Plant, tools, equipment (test equipment, instruments, abrasive wheel etc)
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Residual risk rating
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Detail site observation/site specific control measures/general comments
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Reinstatement (backfill, hot/cold lay, concrete, modular surfaces)
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Residual risk rating
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Detail site observation/site specific control measures/general comments
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Occupational health (manual handling, HAVS, noise, dust, materials & substances)
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Residual risk rating
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Detail site observation/site specific control measures/general comments
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Environmental (water courses, trees, segregation of materials & weather etc)
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Residual risk rating
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Detail site observation/site specific control measures/general comments
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Confined spaces / manholes
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Residual risk rating
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Detail site observation/site specific control measures/general comments
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Fibre cables
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Residual risk rating
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Detail site observation/site specific control measures/general comments
PPE
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Tick the PPR appropriate for the task
- Overalls
- Safety boots
- Hi-visibility vest
- Safety glasses
- Goggles
- Face visor
- General purpose gloves
- LV/HV gloves
- Ear protection
- Dust mask
- Hard hat
- Respirator
- Other
Gas Test Record
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GDU Calibrated and working
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Calibration date
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Chamber number
- FW2
- FW4
- FW6
- FW10
- FW11
- JRC11
- JRC12
- Manhole
- JB23
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Time
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Positive/Negative
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Name
- Adam
- Ryan
- Alex
- Jamie
- Lee
- Sully
- Leo
- Jack
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Chamber Number
- FW2
- FW4
- FW6
- FW10
- FW11
- JRC11
- JRC12
- Manhole
- JB23
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Time
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Positive/Negative
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Name
- Adam
- Ryan
- Alex
- Jamie
- Lee
- Sully
- Leo
- Jack
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Chamber Number
- FW2
- FW4
- FW6
- FW10
- FW11
- JRC11
- JRC12
- Manhole
- JB23
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Time
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Positive/Negative
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Name
- Adam
- Ryan
- Alex
- Jamie
- Lee
- Sully
- Leo
- Jack
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Chamber Number
- FW2
- FW4
- FW6
- FW10
- FW11
- JRC11
- JRC12
- Manhole
- JB23
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Time
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Positive/Negative
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Name
- Adam
- Ryan
- Alex
- Jamie
- Lee
- Sully
- Leo
- Jack
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Chamber Number
- FW2
- FW4
- FW6
- FW10
- FW11
- JRC11
- JRC12
- Manhole
- JB23
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Time
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Positive/Negative
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Name
- Adam
- Ryan
- Alex
- Jamie
- Lee
- Sully
- Leo
- Jack
Chamber Locations
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Chamber
- FW2
- FW4
- FW6
- FW10
- FW11
- JRC11
- JRC12
- Manhole
- JB23
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Location
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Chamber
- FW2
- FW4
- FW6
- FW10
- FW11
- JRC11
- JRC12
- Manhole
- JB23
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Location
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Chamber
- FW2
- FW4
- FW6
- FW10
- FW11
- JRC11
- JRC12
- Manhole
- JB23
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Location
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Chamber
- FW2
- FW4
- FW6
- FW10
- FW11
- JRC11
- JRC12
- Manhole
- JB23
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Location
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Chamber
- FW2
- FW4
- FW6
- FW10
- FW11
- JRC11
- JRC12
- Manhole
- JB23
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Location
Staff & Visitors
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Give the name of all staff working on this site
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Give the name and company of any visitors to this site
Sign off
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To be signed ONLY by those undertaking the initial site specific risk assessment
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Name
- Adam
- Ryan
- Alex
- Jamie
- Lee
- Sully
- Leo
- Jack
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Sign to say you are familiar with the task to be undertaken and the precautions required, in order to complete the works without endangering ourselves or others.
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Name
- Adam
- Ryan
- Alex
- Jamie
- Lee
- Sully
- Leo
- Jack
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Sign to say you are familiar with the task to be undertaken and the precautions required, in order to complete the works without endangering ourselves or others.
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Name
- Adam
- Ryan
- Alex
- Jamie
- Lee
- Sully
- Leo
- Jack
-
Sign to say you are familiar with the task to be undertaken and the precautions required, in order to complete the works without endangering ourselves or others.
-
Name
- Adam
- Ryan
- Alex
- Jamie
- Lee
- Sully
- Leo
- Jack
-
Sign to say you are familiar with the task to be undertaken and the precautions required, in order to complete the works without endangering ourselves or others.
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undefined
- Adam
- Ryan
- Alex
- Jamie
- Lee
- Sully
- Leo
- Jack
