Title Page

  • Conducted on

  • Company name

  • Name

  • Site Location

Take 5 sections

  • Are you familiar with how to report hazards & incidents?

  • Do you have the correct procedures and equipment to do the work safely?

  • Is there appropriate separation of vehicles and people during the proposed work?

  • Is all required electrical/mechanical equipment in a safe condition?

  • Have you consulted with workers about the task and the safe way to do it?

  • Do you have all necessary PPE?

  • Have you got a safe way of getting in and out of your work area?

  • Sign off

  • Comments/ hazards

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.