Title Page

  • TASK

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • DOCUMENT NUMBER

PERSONNEL AT RISK

  • PERSONNEL AT RISK

PPE REQUIREMENTS

  • PLEASE TICK ALL THAT ARE APPLICABLE

JOB SAFETY OBSERVATIONS & ACTIONS PLEASE SELECT HAZZARDS AS APPROPRIATE.

  • 1. MOVING PLANT OR EQUIPMENT - WILL THE TASK UTILISE OR BE UNDERTAKEN WITH OR NEAR TO TO MOVING PLANT /EQUIPMENT.

  • YOU MUST OBEY SIGNS AND NOTICES, YOU MUST NOT REMOVE GUARDS WHILST PLANT IS OPERATING. YOU MUST ISOLATE IF NECESSARY VIA LOCK OFF, TAG OUT, TRY OUT (LOTOTO).

  • ARE ADDITIONAL CONTROL MEASURES REQUIRED? IF YES DETAIL ADDITIONAL CONTROL MEASURES IMPLEMENTED.

  • IS IT SAFE TO PROCEED?

  • ASSOCIATED WORKS MUST CEASE UNTIL SUITABLE AND APPROPRIATE CONTROL MEASURES HAVE BEEN IMPLEMENTED AND AGREED WITH THE APPROPRIATE MEMBERS OF THE SENIOR MANAGEMENT TEAM AND THE SITE QUARRY MANAGER.

  • 2. POTENTIAL CONTACT WITH POWER SUPPLY OR ELECTRICAL SUPPLIES.

  • ISOLATE THE SUPPLY YOU MUST ISOLATE IF NECESSARY VIA LOCK OFF, TAG OUT, TRY OUT (LOTOTO). ALWYAS FOLLOW AUTHOURISED ROUTES UNDER OR NEAR POWER SUPPLIES.

  • ARE ADDITIONAL CONTROL MEASURES REQUIRED? IF YES DETAIL ADDITIONAL CONTROL MEASURES IMPLEMENTED.

  • IS IT SAFE TO PROCEED?

  • ASSOCIATED WORKS MUST CEASE UNTIL SUITABLE AND APPROPRIATE CONTROL MEASURES HAVE BEEN IMPLEMENTED AND AGREED WITH THE APPROPRIATE MEMBERS OF THE SENIOR MANAGEMENT TEAM AND THE SITE QUARRY MANAGER.

  • 3. UNEVEN SURFACES - ARE THERE ANY UNEVEN SURFACES

  • HAVE ACCEPTABLE UNDERFOOT CONDITIONS BEEN ESTABLISHED?

  • ARE ADDITIONAL CONTROL MEASURES REQUIRED? IF YES DETAIL ADDITIONAL CONTROL MEASURES IMPLEMENTED.

  • ASSOCIATED WORKS MUST CEASE UNTIL SUITABLE AND APPROPRIATE CONTROL MEASURES HAVE BEEN IMPLEMENTED AND AGREED WITH THE APPROPRIATE MEMBERS OF THE SENIOR MANAGEMENT TEAM AND THE SITE QUARRY MANAGER.

  • IS IT SAFE TO PROCEED WITH CURRENT WORKS?

  • 4. SLIP/TRIP/FALL IS THERE POTENTIAL FOR SLIP/TRPS OR FALL ASSOCIATED WITH THE TASK?

  • Do the control measures of Inspecting the area and removing the identified slip/trip/fall hazard rectify the problem?

  • PLEASE DETAIL ANY AND ALL ADDITIONAL CONTROLS MEASURES IMPLEMNENTED

  • IS IT SAFE TO PROCEED WITH THE TASK?

  • ASSOCIATED WORKS MUST CEASE UNTIL SUITABLE AND APPROPRIATE CONTROL MEASURES HAVE BEEN IMPLEMENTED AND AGREED WITH THE APPROPRIATE MEMBERS OF THE SENIOR MANAGEMENT TEAM AND THE SITE QUARRY MANAGER.

  • 5. LIFTING/SLINGING - IS THERE A REQUIREMENT FOR ANY LIFTING/SLINGING ASSOCIATED WITH THE TASK?

  • HAS ONLY THE CORRECT CERTIFIED/INSPECTED/TAGGED EQUIPMENT BEEN IDENTIFIED FOR USE IN THE SLINGING /LIFTING?

  • ASSOCIATED WORKS MUST CEASE UNTIL SUITABLE AND APPROPRIATE CONTROL MEASURES HAVE BEEN DOCUMENTED, IMPLEMENTED AND AGREED WITH THE APPROPRIATE MEMBERS OF THE SENIOR MANAGEMENT TEAM AND THE SITE QUARRY MANAGER.

  • ARE ALL INDIVIDUALS ASSOCIATED OR WITHIN THE VICINITY OF THE TASK AWARE THAT THERE ARE TO BE NO MOVEMENT OR OPERATIONS UNDER SUSPENDED LOADS?

  • I AM SIGINING THIS OFF AS THE SENIOR PERSON IN CONTROL OF THIS OPERATION TO CONFIRM THAT THIS HAS BEEN COMUNICATED TO ALL RELEVANT STAFF

  • HAS THE WINDSPEED BEEN CHECKED TO ENSURE THAT IT IS BELOW THE 18MPH THRESHOLD (A CLEAR INDICATION OF THE WINDSPEED BEING ABOVE THIS THRESHOLD IS WHEN LEAVES AND DEBRIS ARE BEING LIFTED FROM GROUND LEVEL BY WIND GUSTS).

  • NO ASSOCIATED TASKS TO BE CONDUCTED UNTIL THIS HAS BEEN CONFIRMED.

  • 6. AIRBORNE PARTICULATE/DUST IS THERE EVIDENCE/POTENTIAL OF HARMFUL PARTICULATE OR DUSTS BEING PRODUCED AS PART OF THIS TASK?

  • CAN LOCAL VENTILATION BE USE TO DISPERSE THE LEVEL OF DUST TO AN ACCEPTABLE LEVEL?

  • HAS THE DUST BEEN IDENTIFIED AND A SUITABLE FACE FITTED DUST MASK PROVIDED?

  • CAN DUST SUPPRESSION BE ACHIEVED BY ALTERNATIVE METHODS SUCH AS ( TRACTOR BOWSER WATER SUPPRESION)? DOCUMENT METHOD OF CONTROL IN THE NOTES SECTION.

  • ASSOCIATED WORKS MUST CEASE UNTIL SUITABLE AND APPROPRIATE CONTROL MEASURES HAVE BEEN DOCUMENTED, IMPLEMENTED AND AGREED WITH THE APPROPRIATE MEMBERS OF THE SENIOR MANAGEMENT TEAM AND THE SITE QUARRY MANAGER.

  • 7. FUME OR VAPOUR - IS THERE A POTENTIAL FOR HARMFUL FUME OR VAPOUR TO BE PRESENT?

  • IS IT POSSIBLE TO IDENTIFY AND ISLOATE THE THE SOURCE OF THE FUME/VAPOUR

  • IS THERE ADEQUATE VENTILATION IN PLACE TO ENSURE REMOVAL /CAPTURE OF HARMFUL VAPOUR

  • ASSOCIATED WORKS MUST CEASE UNTIL SUITABLE AND APPROPRIATE CONTROL MEASURES HAVE BEEN DOCUMENTED, IMPLEMENTED AND AGREED WITH THE APPROPRIATE MEMBERS OF THE SENIOR MANAGEMENT TEAM AND THE SITE QUARRY MANAGER.

  • 8. IS THERE POTENTIAL FOR STORED ENERGY (CONSIDER AIR, FLUID, RESIDUAL VOLTAGE)

  • HAS THE POTENTIAL SOURCE OF ENERGY BEEN IDENTIFIED AND REDUCED TO A ZERO STATE. FOR EXAMPLE (GAS REMOVED FROM PRESSURISED CYLINDERS OR THE APPROPRIATE LOCK OFF POINTS BEEN LOCKED OFF TAGGED OFF AND TRIED OUT, LOTOTO)

  • ASSOCIATED WORKS MUST CEASE UNTIL SUITABLE AND APPROPRIATE CONTROL MEASURES HAVE BEEN DOCUMENTED, IMPLEMENTED AND AGREED WITH THE APPROPRIATE MEMBERS OF THE SENIOR MANAGEMENT TEAM AND THE SITE QUARRY MANAGER.

  • 9. WILL NOISE LEVELS BE ABOVE THE THRESHOLD LIMITS OF 80dB FOR RECOMMENDED USE OF HEARING PROTECTION AND OR 85dB FOR MANDATORY OBLIGATION OF USE AND MANAGEMENT OF HEARING PROTECTION?

  • IDENTIFY THE SOURCE OF NOISE AND REDUCE THE dB LEVELS TO APPROPRIATE LEVELS

  • i HAVE ADVISE INDIVIDUALS OF THE NOISE LEVELS IN THE LOCATION AND PROVIDE AND MANAGE THE MANDATORY WEARING OF CERTIFIED PPE TO CONTROL EXPOSURE.

  • 10. IS THERE A REQUIREMENT TO WORK AT HEIGHT USING LADDERS?

  • LADDER THE TO BE USE SUITABLE FOR THE TASK ie THE CORRECT CLASSIFICATION

  • HAVE THE PERMIT TO WORK AND WORKING AT HEIGHT DOCUMENTATION BEEN COMPLETED

  • STOP DO NOT PROCCED WITH THE ASSOCIATED TASK UNTIL THE PERMIT TO WORK AND WORKING AT HEIGHT DOCUMENTATION ARE COMPLETED!

  • 11. IS THERE THE POTENTIAL FOR IMPACT WITH A VEHICHLE

  • HAVE ALL OPERATORS OF ALL LARGE MACHINERY BEEN INFORMED OF THE LOCATION OF THE PLANNED WORKS/

  • THIS IS BEING SIGNED AS ACKNOWLEDGMENT OF COMMUNICATION TO ALL OPERATORS OF THE LOCATION OF PLANNED WORKS.

  • HAS THE PROPOSED WORK AREA BEEN DEFINED BY SUITABLE BARRIERS AND SIGNAGE

  • STOP! DO NOT PROCEED UNTIL THE PROPOSED WORK AREA HAS BEEN CLEARLY DEFINED BY BARRIERS & SIGNAGE.

  • 12. CONFINED SPACE- IS THERE A REQUIREMENT TO WORK WITHIN A CONFINED SPACE ASSOCIATED WITH THTIS TASK?

  • HAS THE FREE FLOW OF AIR THROUGH THE WORKING AREA BEEN ACHIEVED

  • IS GAS MONIOTRING REQUIREDTO ENSURE GAS LEVELS ARE MONITORED TO PREVENT THEM FROM REACHING POTENTIALY HARMFUL/DANGEROUS LEVELS

  • STOP! CEASE ALL ASSOCIATED WORKS UNTIL GAS MONITORING IS COMENCED AND GAS LEVELS ARE APPROPIATE.

  • HAS THE CONFINED SPACE WORK PERMIT BEEN COMPLETED

  • STOP! CEASE ALL ASSOCIATED WORKS UNTIL THE CONFINED SPACE WORK PERMIT HAS BEEN COMPLETED AND APPROVED.

  • 13. HOT WORKS - IS A HOT WORK PERMIT REQUIRED FOR TASKS ASSOCIATED WITHIN THE SCOPE OF THIS JOB?

  • IS THE WELDING EQUIPMENT WELL MAINTAINED, SERVICED, INSPECTED AND APPEARS TO BE IN A GOOD WORKING CONDITION.

  • STOP! CEASE ALL ASSOCIATED WORKS UNTIL ALL CONCERNS/DEFECTS BEEN RECTIFIED AND APPROVED.

  • IS ALL OF THE RECOMENDED PPE AVAILABLE FOR USE?

  • IF THERE IS A NEED TO UNDERTAKE WELDING NEAR TO COMBUSTIBLE MATERIAL? IS THIS REFLECTED IN THE WORK PERMIT?

  • STOP! CEASE ALL ASSOCIATED WORKS UNTIL THE HOT WORK PERMIT HAS BEEN COMPLETED AND APPROVED.

  • 14. IS THERE THE POTENTIAL TO BE STRUCK BY A FALLING , MOVING OR FLYING OBJECT ASSOCIATED WITH THIS TASK?

  • WHERE THERE IS A POTENTIAL FOR RESIDUAL ENERGY HAS THE SOURCE OF THE RESIDUAL ENERGY BEEN REDUCED TO ZERO AND ISLOATED APPROPRIATELY?

  • STOP! CEASE ALL ASSOCIATED WORKS UNTIL THE SOUORCE OF THE RESIDUAL ENERGY IS REDUCED TO ZERO OR THE SOURCE IS APPROPRIATELY ISOLATED (LOCK OUT TAG OUT TRY OUT - LOTOTO).

  • IS THE AREA APPROPRIATELY SIGNED AND CORDONED OFF?

  • 15. MANUAL HANDLING - IS MANUAL HANDLING ASSOCIATED WITH THE TASK

  • WHERE POSSIBLE USE ONLY APPROVED AND CERTIFIED MECHANICAL LIFTING AIDS. REDUCE LOADS BY SHARED LIFTING. UTILISE CORRECT LIFTING POSTURE ie LIFTING THROUGH THE LEGS NOT THE BACK.

  • 16. WEATHER/VISIBILITY - ARE THE CONDITIONS LIKELY TO AFFECT THE TASK

  • IS THE ISSUE ASSOCITAED WITH ICE AND OR SNOW?

  • ENSURE SALT SPREADING / SNOW CLEARANCE IS CARRIED OUT

  • IS VISIBILTY RESTRICTED (EXAMPLE: FOG)

  • STOP! TASKS ASSOCIATED WITH THIS JOB MUST PROHIBITED UNTIL CONDITIONS IMPROVE.

  • 17. COSHH - DO ELEMENTS OF THISJOB UTILISE MATERIALS THAT ARE COSHH RELATED

  • READ AND UNDERSTAND THE RELEVANT MATERIAL SAFETY DATA SHEETS (MSDS) ENSURE ALL APPROPRIATE PPE AND CONTROL MEASURES ARE USED. IF THERE IS NO MSDS THAN THE TASK MUST BE PROHIBITED UNTIL THE APPROPRIATE MDSD IS AVAILABLE.

  • 18. ACCESS AND EGRESS - ASSOCIATED WITH THIS TASK WILL THERE REQUIREMENTS DIFFERENT FROM THE NORM ASSOICATED WITH ACCESS & EGRESS?

  • IDENTIFY AND AND EXPLAIN AREAS WHERE 3 POINTS OF CONTACT PRICIPLE IS REQUIRED. EXPLAIN THE USE OF ONLY CERTIFIED AND APPROVED WALKWAYS

  • 19. DROWNING/WORKING NEAR WATER

  • IF SAMPLING WATER USE LONG REACH (SAFE BY DISTANCE) EQUIPMENT

  • ALWAYS USED APPROVED/CERTIFIED WALKWAYS NEAR WATER.

  • WHEN WORKING AT THE WATERS AEDGE PERSONAL BOUYANCY EQUIPMENT MUST BE USED ALONG WITH A BUDDY/WATCHMAN SYSTEM

  • WASH HANDS/OPEN WOUNDS OR CUTS TO REDUCE THE RISK OF INFECTIONS (LEPTOSPIROSIS/WEILS DISEASE IS AN INFECTION THAT CAN BE CONTRACTED FOLLOWING CONTACT WITH OPEN WATER SITES).

EQUIPMENT TO BE UTILISED

  • PLEASE DETAIL IN THE NOTES SECTION BELOW, ALL EQUIPMENT TO BE USED DEFINE BY ACTION NUMBER I.E. 18 ACCESS AND EGRESS.

ADDITIONAL HAZARDS IDENTIFIED ALONG WITH THE APPROPRIATE CONTROL MEASURE ADOPTED

SUPPLIMENTARY INFORMATION.

ADDITIONAL DETAIL

  • DETAIL EQUIPMENT TO BE USED.

  • DETAIL ADDITIONAL HAZARDS AND APPROPRIATE CONTROL MEASURES AS APPROPRIATE

  • DESCRIPTION OF SAFE WORKING METHOD. AND STAGES OF WORK.

  • SUPERVISION (PERSON IN CONTROL OF THE TASK).

  • IF REQUIRED PHOTOS CAN BE ADDED HERE.

  • IF REQUIRED DIAGRAMS CAN BE ADDED HERE.

LOCK OUT, TAG OUT, TEST OUT (LOTOTO)

  • IF A LOCK OFF IS REQUIRED ALL OPERATIVES MUST FOLLOW SMITHS)BLETCHINGTON) ISOLATION POLICY TO ENSURE THAT ALL RELEVLANT EQUIPMENT IS SAFE. TO ALLOW WORK TO PROCEED. ALL OPERATIVES MUST COMPLETE THE ISOLATION REGISTER LOCATED IN ALL KEY SITE ISOLATION POINTS. ALL ISOLATION WORK MUST FOLLOW THE FOLLOWING PROCESS.

  • IS A LOCK OFF (LOTOTO) REQUIRED?

  • 1. PREPARE - HAS THE MACHINE/LOCATION BEEN PRPEARED?

  • STOP! DO NOT PROCEED ANY FURTHER PLEASE REFER TO THE PROJECT MANAGER/SUPERVISOR IN CONTROL OF THE JOB.

  • 2. NOTIFY - HAVE ALL RELEVANT AFFECTED INDIVIDUALS BEEN NOTIFIED OF THE REQUIREMENT TO LOCK OFF?

  • STOP! DO NOT PROCEED ANY FURTHER PLEASE REFER TO THE PROJECT MANAGER/SUPERVISOR IN CONTROL OF THE JOB.

  • 3. TURN OFF / SHUT DOWN - HAS THE APPROPRIATE MACHINERY BEEN TURNED OFF/SHUT DOWN?

  • STOP! DO NOT PROCEED ANY FURTHER PLEASE REFER TO THE PROJECT MANAGER/SUPERVISOR IN CONTROL OF THE JOB.

  • 4. ISOLATE - HAS THE ITEM BEEN ISLOATED?

  • STOP! DO NOT PROCEED ANY FURTHER PLEASE REFER TO THE PROJECT MANAGER/SUPERVISOR IN CONTROL OF THE JOB.

  • 5. APPLY LOCK - HAVE ALL RELEVANT LOCKS BEEN APPLIED.

  • STOP! DO NOT PROCEED ANY FURTHER PLEASE REFER TO THE PROJECT MANAGER/SUPERVISOR IN CONTROL OF THE JOB.

  • 6. ENSURE ZERO ENERGY STATE - HAS A STATE OF ZERO ENERGY BEEN ACHEIVED?

  • STOP! DO NOT PROCEED ANY FURTHER PLEASE REFER TO THE PROJECT MANAGER/SUPERVISOR IN CONTROL OF THE JOB.

  • 7. TRY OUT - HAS THE ITEM BEEN "TRIED OUT" TO PROVE A ZERO STATE OF ENERGY?

  • STOP! DO NOT PROCEED ANY FURTHER PLEASE REFER TO THE PROJECT MANAGER/SUPERVISOR IN CONTROL OF THE JOB.

  • 8. PERFORM TASK - SIGNED AS AUTHOURISATION TO PERFORM THE TASK

ENVIRONMENTAL CONSIDERATIONS

  • OIL SPILLAGE - WAS THERE AN OCCURENCE OF A SPILLAGE OF OIL?

  • ALL OIL SPILLAGES MUST BE REPORTED TO A MEMBER OF SITE MANAGEMENT. FROM HERE THE SITUATION CAN BE ASSESSED AND A SUITABLE SPILL KIT CAN DEPLOYED.

  • DISPOSAL OF OIL FILTERS/WIPES - IS THERE A NEED TO DISPOSE OF FILTERS AND WIPES?

  • FILTERS OR MATERIAL THAT HAS BEEN CONTAMINATED WITH OIL BASED SUBSTANCES CAN BE DISPOSED OF VIA THE ONSITE OIL DISPOSAL BIN FACILITY. - SEEK GUIDANCE FROM A SITE SUPERVISOR OR REFER TO THE SITE INDUCTION FOR BIN LOCATIONS.

  • POST JOB CLEAN UP - IS A POST JOB CLEANUP REQUIRED?

  • UPON COMPLETION OF WORKS , INSPECT THE AREA FOR FOR ANY EVIDENCE OF THE SPILT SUBSTANCE. IN THE EVENT OF A SPILL/LEAKSTILL BEING PRESENT NOTIFY A SUPERVISOR AND DEPLY A RELEVANT SPILL KIT.

PERSONS CARRYING OUT THE ASSESSMENT.

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