SITE SURVEY - Basic BST

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

SITE SPECIFIC INFORMATION

• Ref:

  Yes

  No

  N/A

• Date Of Survey

  Date

• Site address

  Yes

  No

  N/A

• Building Description

  Yes

  No

  N/A

• Surveyor

  Yes

  No

  N/A

• Ref:

• Requested By:

  Yes

  No

  N/A

• Ref No.

  Yes

  No

  N/A

• PO Number

  Yes

  No

  N/A

• Reference No.

  Yes

  No

  N/A

• Date Of Survey

  Date

• Client Contact Name

  Yes

  No

  N/A

• Client Contact Number

  Yes

  No

  N/A

• Pre Advised Site Access Comments

  Yes

  No

  N/A

Delivery Crew Options

• Does this delivery/installation require a crew

  Yes

  No

  N/A

• How many crew members

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Estimated time to complete

  Select 30 mins 1 Hour 1.5 Hour 2 Hours 2.5 Hours 3 Hours 3.5 Hours 4 Hours All Day

  • 30 mins
  • 1 Hour
  • 1.5 Hour
  • 2 Hours
  • 2.5 Hours
  • 3 Hours
  • 3.5 Hours
  • 4 Hours
  • All Day

Vehicle

• What Type of Vehicle Required

  Select Tail Lift Vehicle Small Van MWB Van LWB Van Luton Luton Tai-Lift 7.5t 7.5t Tail Lift 18t Tail Lift

  • Tail Lift Vehicle
  • Small Van
  • MWB Van
  • LWB Van
  • Luton
  • Luton Tai-Lift
  • 7.5t
  • 7.5t Tail Lift
  • 18t Tail Lift

Security Clearance

• Are special permits/passes/keys required?

  Yes

  No

  N/A

• Are Vehicle & Driver details required

  Yes

  No

  N/A

• Security X Clearance required

  Yes

  No

  N/A

• Is the delivery/installation out of hours?

  Yes

  No

  N/A

• At what time will this take place

  Date

Equipment Details

• Description of Equipment: (BOX ID)

  Yes

  No

  N/A

• PID:

  Yes

  No

  N/A

• Dimensions

• Width D

  Yes

  No

  N/A

• Depth

  Yes

  No

  N/A

• Height

  Yes

  No

  N/A

• Weight

  Yes

  No

  N/A

• Quantity

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Final Placement Location

• Has the client indicated that advance notice is required?

  Yes

  No

  N/A

• Hours of access

  Yes

  No

  N/A

• From (time)

  Date

• To (Time)

  Date

Site Preparation

• Unloading area to final placement

• Is the the equipment FINAL location Ground, 1st Floor?

  Yes

  No

  N/A

• Estimated distance from unloading area

  Select 10m 20m 30m 40m 50m 60m 70m 80m 90m 100m

  • 10m
  • 20m
  • 30m
  • 40m
  • 50m
  • 60m
  • 70m
  • 80m
  • 90m
  • 100m

• If the installation is NOT ON THE GROUND FLOOR, what equipment is to be used

• Equipment to be used

  Lift

  Hoist

  Stairwalker

  Other

• Complete if Lift is being considered

• Photograph of Lift

  Media

• Can lift be used for equipment/consumables?

  Yes

  No

  N/A

• Dimensions of the Lift (L'W'H)

  Yes

  No

  N/A

• Maximum load of lift (Kgs)

  Yes

  No

  N/A

• Maximum opening size of Lift Doors (H'W)

  Yes

  No

  N/A

• Complete if Stairwalker is being considered

• Number of flights of Stairs & Steps per flight

  Select 1 2 3 4 5 6 7 8 9 10 12 13

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 12
  • 13

• Number of landings

  1

  2

  3

  4

• Are the stairs & Landings wide enough for a Stairwalker to be used

  Yes

  No

  N/A

• Photograph of Staircase

  Media

• Rough Sketch and sizes

  Drawing

• What are the dimensions of any doors along the delivery route

  Yes

  No

  N/A

• How many doors along the route

  1

  2

  3

  4

  5

• Is the way clear of any obstruction and large enough for the passage of equipment

  Yes

  No

  N/A

• Photograph of any possible obstructions

  Media

• Rough Sketch of any obstructions with dimensions

  Drawing

Specialist Equipment required

• List all equipment required

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Select Specialist Equipment

  Select Rollers Scoots Plastic Flooring Steel Flooring Bridging tape Shims Blocks Roller Crowbar Sleepers Pallet Truck Scissor Truck 25mm Bubble wrap Cardboard Pallet Digital Photographs Hard Hats Hi-Vis Jackets Gloves Foot Protection Hand Tools

  • Rollers
  • Scoots
  • Plastic Flooring
  • Steel Flooring
  • Bridging tape
  • Shims
  • Blocks
  • Roller Crowbar
  • Sleepers
  • Pallet Truck
  • Scissor Truck
  • 25mm Bubble wrap
  • Cardboard
  • Pallet
  • Digital Photographs
  • Hard Hats
  • Hi-Vis Jackets
  • Gloves
  • Foot Protection
  • Hand Tools

• Other Specialised Equipment specify

  Yes

  No

  N/A

Health & Safety

• Has a site risk assessment been carried out by the Client

  Yes

  No

  N/A

• Has the client shown supplied a copy of the site risk assessment?

  Yes

  No

  N/A

• ACTIONS REQUIRED BY CLIENT

• Action required by client

• ACTIONS THAT BST NEEDS TO UNDERTAKE

• Action required by BST

• Scope of Work & Method

• Describe how the equipment will be taken from point A to point B; from the 'unloading area' to its 'final destination'. Highlight any potential obstructions on route

• Surveyors name

  Yes

  No

  N/A

• Signature

  Drawing

• Date & Time

  Date

Risk Assessment

• HAZARD IDENTIFICATION

• Hazards that are relevant to the installation must be assessed against the possibility of Occurrence of injury and the severity of the injury, and are scored between 1 & 5. The values are then multiplied together to obtain a risk rating

• POSSIBILITY OF (P)

• 1 = The incident is almost certain NOT to occur, only happening in exceptional circumstances

• 2 = Unlikely

• 3 = There is a possibility of it occurring if an additional factor triggers it

• 4 = Likely

• 5 = There is almost a 100% chance of the incident occurring

• SEVERITY OF (S)

• 1 = Minor injury, for example a small knock that does not require first aid

• 2 = An accident requiring first aid

• 3 = A serious accident, e.g. A broken bone

• 4 = A major injury resulting in a number of days off work

• 5 = Death

RISK RATING - A HAZARD WITH A RISK RATING OF 6 OR ABOVE, OR A POSSIBILITY OF SEVERITY OF SCORE 5 REQUIRES IMMEDIATE CORRECTIVE ACTION

TRIP HAZARD

• HAZARD

• Trip Hazards - Examples include pipe work, cabling,obstructions, work being carried out by other contractors

  Yes

  No

• Possibility of (P)

  1

  2

  3

  4

  5

• Severity of (S)

  1

  2

  3

  4

  5

• Risk Rating

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Picture of Hazard

  Media

• Action required

SLIP HAZARD

• HAZARD

• Slip Hazard - example include wet flooring, oil, mud, ice etc

  Yes

  No

• Possibility of (P)

  1

  2

  3

  4

  5

• Severity of (S)

  1

  2

  3

  4

  5

• Risk Rating

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Picture of Hazard

  Media

• Action required

FALLING OBJECT HAZARD

• HAZARD

• Falling Objects Hazard - Are there people working overhead, leaks from overhead pipes etc.

  Yes

  No

• Possibility of (P)

  1

  2

  3

  4

  5

• Severity of (S)

  1

  2

  3

  4

  5

• Risk Rating

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Picture of Hazard

  Media

• Action required

ILLUMINATION HAZARD

• Hazard

• Illumination Hazard - Is there inadequate illumination to conduct work safely,is more light required

  Yes

  No

• Possibility of (P)

  1

  2

  3

  4

  5

• Severity of (S)

  1

  2

  3

  4

  5

• Risk Rating

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Action required

FIRE HAZARD

• HAZARD

• Fire Hazard - Presence of flammable materials, e.g. Paints, waste materials etc.

  Yes

  No

• Possibility of (P)

  1

  2

  3

  4

  5

• Severity of (S)

  1

  2

  3

  4

  5

• Risk Rating

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Action required

NOISE FROM SITE SERVICES

• HAZARD

• Noise from Site Services - Presence of air conditioning units, activities of other contractors or employees

  Yes

  No

• Possibility of (P)

  1

  2

  3

  4

  5

• Severity of (S)

  1

  2

  3

  4

  5

• Risk Rating

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Action required

EXPOSURE TO DISEASE

• HAZARD

• Exposure to Disease Hazard - Examples include Weil's Disease from rats urine & Lyme's Disease from Tick bites

  Yes

  No

• Possibility of (P)

  1

  2

  3

  4

  5

• Severity of (S)

  1

  2

  3

  4

  5

• Risk Rating

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Action required

EXPOSURE TO HAZARDOUS SUBSTANCES

• HAZARD

• Exposure to Hazardous Substances - Examples include asbestos, chemicals, biological agents, fibreglass insulation etc.

  Yes

  No

• Possibility of (P)

  1

  2

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  4

  5

• Severity of (S)

  1

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  4

  5

• Risk Rating

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• Action required

HAZARDS TO EMPLOYEES FROM OTHER TRADES WORKING ON SITE

• HAZARD

• Hazards to employees from other trades working on site

  Yes

  No

• Possibility of (P)

  1

  2

  3

  4

  5

• Severity of (S)

  1

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  4

  5

• Risk Rating

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• Action required

RISK OF FALLING

• HAZARD

• Risk of Falling Hazard - Examples include working at height, working in areas that cannot support weight, e.g. Roofs, etc.

  Yes

  No

• Possibility of (P)

  1

  2

  3

  4

  5

• Severity of (S)

  1

  2

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  4

  5

• Risk Rating

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• Action required

ROADSIDE WORKING

• HAZARD

• Roadside Working Hazard - Are the crews working on or near a road? Is there any Traffic Management

  Yes

  No

• Possibility of (P)

  1

  2

  3

  4

  5

• Severity of (S)

  1

  2

  3

  4

  5

• Risk Rating

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• Action required

MANUAL HANDLING

• HAZARD

• Manual Handling Hazards - Lifting of any description

  Yes

  No

• Possibility of (P)

  1

  2

  3

  4

  5

• Severity of (S)

  1

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  3

  4

  5

• Risk Rating

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• Risk Rating

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• Action required

• ********** IMPORTANT NOTICE ********** This risk assessment part of the site survey has to be reviewed in at least 3 months or in the case of changes in the work situation (activity, environment, equipment etc) or in legislation

• Signature

  Sign