Title Page
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Conducted on
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Prepared by
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Location
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Are you competent in completing the work at hand?
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Do you know the company’s health & safety rules?
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Are you familiar with how to report hazards & incidents?
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Are there emergency facilities and an evacuation procedure/route for the site?
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Do you have access to appropriate emergency and first aid equipment?
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Have you asked the person in charge about all relevant hazards?
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Do you have the correct procedures and equipment to do the work safely?
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Is all required electrical/mechanical equipment in a safe condition?
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Are hazardous/dangerous substances used and stored according to their safety data sheets?
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Have you consulted with workers about the task and the safe way to do it?
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Do you have all necessary PPE?
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Have you got a safe way of getting in and out of your work area?
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Have any manual handling risks been identified and accessed?
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Was there any safety issues or incidents to report? Minor or major?
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Sign off
