SITE-SPECIFIC RISK ASSESSMENT

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

CLIENT INFORMATION

• Select date

  Date
• Add location
  Address

• Add drawing

  Drawing

• Add media

  Media

• JOB DISCRIPTION

• CONSERVATION AREA

  conservation area

  contact council

• COUNCIL CONTACTED

  Yes

  No

  N/A

• DISPOSAL OF ARISINGS BY FTS

  Yes

  No

  N/A

• TRAFFIC CONTROL NEEDED

  Yes

  No

  N/A

GENERIC ASSESSMENT SITE CONSIDERATIONS REF 2.0

• WORK SITE - COMMON FACTORS: a -p ref 2.1

  Yes

  No

  N/A

• POWER LINES REF 2.2

  Yes

  No

  N/A

• OTHER WAY LEAVES REF 2.3

  Yes

  No

  N/A

• BUILDINGS / OBSTRUCTIONS REF 2.4

  Yes

  No

  N/A

• ROADS /FOOTPATHS / PUBLIC AREAS REF 2.5

  Yes

  No

  N/A

• SENSITIVE / EMOTIONALLY CHARGED REF 2.6

  Yes

  No

  N/A

• OTHER (EG OVER WATER, HOSPITAL, SCHOOL, ETC)

  Yes

  No

  N/A

ENVIRONMENTAL CONSIDERATIONS 3.0

• WATERCOURSE REF3.1

  Yes

  No

  N/A

• PROTECTED SPECIES / HABITAT REF 3.2

  Yes

  No

  N/A

• NOISE / DUST REF 3.3

  Yes

  No

  N/A

OPERATIONS REF 4.0

• CHAINSAWS - COMMON FACTORS: a - f REF 4.1

  Yes

  No

  N/A

• TREE CLIMBING - COMMON FACTORS: a- e REF 4.2

  Yes

  No

  N/A

• CHAINSAW IN TREE - COMMON FACTORS: a-c REF 4.3

  Yes

  No

  N/A

• BRANCH REMOVAL REF 4.4

  Yes

  No

  N/A

• LOWERING EQUIPMENT REF 4.5

  Yes

  No

  N/A

• TREE FELLING REF 4.6

  Yes

  No

  N/A

• DE LIMBING AND CROSS CUTTING REF 4.7

  Yes

  No

  N/A

• STORM DAMAGE REF 4.8

  Yes

  No

  N/A

• CHEMICAL APPLICATION REF 4.9

  Yes

  No

  N/A

• OTHER ( eg BRACING FENCING PLANTING ETC

  Yes

  No

  N/A

MACHINERY REF 5.0

• BRUSHWOOD CHIPPER REF 5.1

  Yes

  No

  N/A

• STUMP GRINDER REF REF 5.2

  Yes

  No

  N/A

• WINCH REF 5.3

  Yes

  No

  N/A

• BRUSHCUTTERS CLEARING SAWS REF 5.4

  Yes

  No

  N/A

• HEDGE TRIMMERS REF 5.5

  Yes

  No

  N/A

• MECHANISED POLE PRUNER REF 5.6

  Yes

  No

  N/A

• Select date

  Date

EMERGENCY CONTINGENCIES

• NEAREST LAND LINE PHONE

• NEAREST HOSPITAL

• HELECOPTER LANDING SITE

• STAFF ON SITE SIGNATURES

  Sign