Title Page
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Site Address
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Risk Assessment Completed by
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Job Number
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Date
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Day
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Sunday
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Brief Description of Works
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Persons Likely to be Affected by your Activities
- Staff & Contractors
- Visitors
- Public & Motorists
- Other
Risk Assessment
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ZOI Special instructions: does the task sheet include any specific instructions?
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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ZOI Special Instructions: confirm that all specific instructions have been implemented.
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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Protection of Works/Pedestrians and Vehicles (Red Book)
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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UndergrouncV0vethead Apparatus
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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Excavation(s) (Ground Conditions, Positioning of Spoil, etc) (Excavation Assessment below)
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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Cable / Duct Laying
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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Work Location (Sub-Station, Schools, Level Crossing. Shops and Pedestrian Crossing, etc)
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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Plant, Tools, and Equipment Test Equipment, Instruments. Abrasive Wheel etc)
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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Reinstatement (Backfill, Hot/Cold lay, Concrete, Modular Surfaces)
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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Occupational Health (Manual Handling. HAYS. Noise. Dust. Materials and Substances)
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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Environmental (Water Courses, Trees, segregation of materials and Weather, etc)
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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Confined Spaces/Working at Height
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Generic Risk Assessments Numbers (Team Safety Pack)
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Detail Site Observation/Site Specific Control Measures/General Comments
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Residual Risk Rating
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Personal Protective Equipment (Select those appropriate for the task)
- Flame Retardant Coveralls
- Safety Boots
- Hi Visibility Vest
- Safety Glasses/Goggles
- Face Visor
- Safety Gloves
- Ear Protection
- FP3 Dust Mask
- Hard Hat
- Respirator
- Safety Harness
- Other
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I can confirm that I am in charge of the site, the site is set up, is compliant and all individuals on site are authorised to be working.
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Site Leader Print Name and Sign
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We are familiar with the task to be undertaken and the precautions required, in order to complete the works without endangering ourselves or others.
(Tap "+")
Op
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Op Print Name and Sign
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Record location and rating of each excavation. You can record up to 5 excavations on one Risk Assessment.
Note: A single trench is classified as one excavation.
(Tap "+")
Excavation
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Location
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Total
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Date
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Record all Positive and Negative Gas Tests Below
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Gas Test Record
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GDU Calibrated and Working
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Calibrated Date
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Tap "+"
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Chamber
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Time
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Positive
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Negative
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Signature
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The person in charge of the site must carry out a site specific safety briefing to all persons working on visiting the site and then it must be signed below to show understanding and agreement.
(Tap"+")
Person
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Print Name and Sign
