Site Specific Risk Assessment

Risk Assessment Details

• Document Number

• Risk Assessment Details

  Select
• Location
  Address

• Date / Time

  Date

• Site Supervisor

Client Details

• Client Name

  Select

• Workstream Owner

  Select

• Each identified hazard must have a control measure added as an action.

• HV Electricity Cables / Substation

  Select Safe Risk

  • Safe
  • Risk

• Overhead Power Lines

  Select Safe Risk

  • Safe
  • Risk

• Hazardous Pipelines

  Select Safe Risk

  • Safe
  • Risk

• Parked Cars

  Select Safe Risk

  • Safe
  • Risk

• Poor / Uneven Ground

  Select Safe Risk

  • Safe
  • Risk

• Adverse Weather

  Select Safe Risk

  • Safe
  • Risk

• Adjacent to Water

  Select Safe Risk

  • Safe
  • Risk

• Public Amenity Areas (Shopping Centre)

  Select Safe Risk

  • Safe
  • Risk

• Emergency Services Access

  Select Safe Risk

  • Safe
  • Risk

• Bridge / Culvert

  Select Safe Risk

  • Safe
  • Risk

• Confined Spaces

  Select Safe Risk

  • Safe
  • Risk

• Heavy Traffic / Busy Junction

  Select Safe Risk

  • Safe
  • Risk

• Night Work

  Select Safe Risk

  • Safe
  • Risk

• Restricted Access

  Select Safe Risk

  • Safe
  • Risk

• Work at Height

  Select Safe Risk

  • Safe
  • Risk

• Delivery Bays (Moving HGC Vehicles)

  Select Safe Risk

  • Safe
  • Risk

• Pedestrian Crossing

  Select Safe Risk

  • Safe
  • Risk

• Near Tram / Train Lines

  Select Safe Risk

  • Safe
  • Risk

• Bus Stop

  Select Safe Risk

  • Safe
  • Risk

• School

  Select Safe Risk

  • Safe
  • Risk

• Hi Speed Road (+50 mph)

  Select Safe Risk

  • Safe
  • Risk

• Pub / Hotel

  Select Safe Risk

  • Safe
  • Risk

• Fuel Station

  Select Safe Risk

  • Safe
  • Risk
Additional Control

• Additional hazard not listed.

  Select Safe Risk

  • Safe
  • Risk

• Reason for Visit

PPE Required

• MANDATORY PPE

  

• Ear Protection Required?

  Yes

  No

• Face Mask Required?

  Select Yes No

  • Yes
  • No

• Harness Required?

  Select Yes No

  • Yes
  • No

• Eye Protection Required?

  Select Yes No

  • Yes
  • No

• Helmet Required

  Select Yes No

  • Yes
  • No

• Face Shield Required?

  Select Yes No

  • Yes
  • No

• Respirator Required?

  Select Yes No

  • Yes
  • No

• Protective Clothing / Waders Required?

  Select Yes No

  • Yes
  • No

Communication

• I confirm that the contents of this Risk Assessment have been communicated to my team and understand the Control Measures

  Yes

  No

• I understand that I must inform the Site Supervisor immediately of any changes which may affect health & safety.

  Yes

  No

• If you have ANY concerns about your HEALTH & SAFETY please report them immediately to a Supervisor.

• Yes

  No

Pre-Start Checks

• Is the work area secure?

  Select Yes No

  • Yes
  • No

• Are all necessary construction drawings available and on site?

  Yes

  No

• Has a visual inspection of the work area been carried out?

  Yes

  No

• Has the vehicle Daily Check been completed?

  Yes

  No

• Is adequate Signing, Lighting and Guarding in place to separate pedestrian/vehicular traffic?

  Yes

  No

• Is CoSHH information available for any substances/materials being used?

  Yes

  No

• Is all necessary PPE available for us?

  Yes

  No

• Team Lead / Supervisor Name

• I confirm that the above checks have been made and that measures have been taken to control the risks and they have been fully communicated to the team.

  Sign

• Yes

  No

Site Visitor

• Name of Visitor

• Yes

  No