Title Page

  • Client / Site

  • Conducted on

  • Task

  • Location
  • Names of all persons on site, including visitors.

Part 1 : Get Safe for Work

Before you start Answer the below, if you answer No to any of the Following, please ensure that you inform the Responsible Person and resolve prior to starting any work.

  • Take photographs of your work site BEFORE you set up. Pay particular attention to cracked or broken ground, potholes, any private property that may be impacted by any of the work we are doing.

  • Do you have the right documentation for the job? Risk Assessments, Permits and Method Statements. <br>

  • Are the power tools and leads in good condition?

  • Do you have the right PPE for the job? <br><br>

  • Are ladders tagged and in date for inspection?

  • Is there Safe Access?<br>

  • Traffic Management (if TM in place sign onto their POWRA and take a photo)

  • Signing, lighting and guarding (take a photo of setup from both sides of works before beginning work) - remember all tools/lids etc must be within barriers and any works must be totally surrounded with guarding.

Part 2 : Think - Act

If you Think the Task Requires additional controls - Select At Risk, Describe what is needed prior to commencing work. Implement the Controls and Continue

  • Slips, trip or fall on the same level hazard?

  • Falls From Height

  • Falling or flying objects Hazard?

  • Chemical/Harmful Substances

  • Heat/Fire/Explosion/Hot works

  • Asphyxiation / Drowning

  • Risk to Plant<br>

  • Stationary objects Contact Risk

  • Overturn/Collapse

  • Manual handling<br>

  • Insecure load<br>

  • Moving vehicles<br>

  • Confined spaces (Permit Req’d)<br>

  • Dust/Fumes<br><br>

  • Noise<br><br>

  • Vibration<br><br>

  • Electricity<br><br>

  • Contamination<br><br>

  • Poor lighting<br><br>

  • Temperature<br>

  • Adverse weather<br>

  • Pinch/ Trapping Points<br>

  • Others Please specify

Part 3 : Review

  • Has the Works created any New Hazards<br>

  • Are there any lesson that were learn from the days Works<br>

  • Are there any further safety Suggestions or Concerns Regarding the the days proceedings that you would like to communicate to Management?

  • Before leaving take photos of the site. Include any completed work and any private property where they could claim they had been impacted by our work.

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.