Title Page

  • Conducted on

  • Prepared by

  • Location


  • Task description

  • Take photo of work environment

Before Task Commences

  • Do I clearly understand what is required?

  • Am I trained to do the work and familiar with the equipment/task?

  • Are the tools and equipment in a safe condition?

  • Do I have approved documentation for the task?

  • Am I safe from other activities/tasks in the area?

  • Have I informed others who may be affected by my work?

  • Do I have the correct PPE for the Task?


  • Have I identified any hazards associated with the task?

  • Description of hazards

  • Take photo of hazards

  • Description of controls

Risk Assessment

  • Have all hazard controls been implemented?

  • Have all potential problems been discussed and understood by all?

  • Can the Task proceed safely?


  • Other observations comments

  • Sign off

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.