Title Page

  • Site Number & Location

  • Conducted on

  • Name of Worker Conducting Assessment

  • Does this site require tracking?

  • Side tracking

  • What size is the site?

  • what size is the site?

  • bottom tracking

  • What size is the site?

  • what size is the site?

  • Side tracking

  • What size is the site?

  • what size is the site?

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  • Does the site require ratchets?

  • How many ratchets does is required?

  • Does the structure require bracing?

  • Give a brief description of what needs to be fixed.

  • Are there any access issues that need to be addressed? (eg. new gates, locks or keys required)

  • Give a brief description of changes

  • Please get a photo of the access changes.

  • is there any changes/ problems to fixed ladders or catwalks? (e.g Damaged or missing hatches, broken welds or loose ladder rungs).

  • give a brief description of issues.

  • get a photo of any issues

  • Please list any other issues that you have come across that needs to be addressed.

sign off section

  • Team leader onsite

  • team member filing out assessment.

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.