Title Page
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Task Title
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Conducted on
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Prepared by
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Location
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Technician Name
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Date SSOW / RA signed
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Asset Reg
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Asset Type
Safe Person
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Describe SSOW
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Does the technician have the PPE relevant to the task
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Is the technician competent to carry out task
Safe Equipment
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Visual pre use check and safe for use
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Correct equipment available to use for relevant task
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Does any equipment require a formal pre use check
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Is the technician using the equipment for its intended purpose
Safe Environment
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Is the area free of obstruction / hazards
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Is there adequate lighting / workspace
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Is the vehicle / trailer isolated
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Is the area segregated as per SSOW
Observing
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Has the technician carried out the relevant task as per SSOW / RA
Next Steps & Notes
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Auditor