Page 1: Initial questions
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Todays Date
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Person doing this report
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Location
Page 2: Main checklist
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Who is on site today?
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Please list who the other people on site are
Emergency Plans
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Who is your first aid rep on site today?
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Where is your first aid kit located?
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Have you talked about your emergency plan today? <br>***3 long blasts on any vehicle horn warning everyone to immediately stop and head to the emergency assembly point***
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STOP what you are doing and inform everyone of the emergency plan for this site. Mark yes when this has been done.
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Where is your emergency assembly point on this worksite?
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Where is your fire extinguisher located?
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Is the correct PPE worn by everyone on site today?
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Please provide details of who has a PPE issue, does it need to be repaired or replaced?
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Is there any hazardous material on site today?
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Is there a MSDS on site for the hazardous material?<br>Please fill in the Job Hazards section
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Is the Hazard board and signage up to date?
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What is the issue with it? Does it need repairing? Replacing? Or updating?
General Site Tidiness and Access Ways
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Clear, safe access to work areas?
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Who is going to resolve this and when?
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Are the stairways and access ways clear
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Who is going to resolve this and when?
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Fencing and gates secure?
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Who is going to resolve this and when?
Equipment in Use
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Is there any damage you need to report about any tools or equipment?
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What needs to be repaired or replaced?
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Are all appropriate safety guards in place and in good condition?
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PLEASE TAG OUT THIS EQUIPMENT/TOOL SO IT CAN'T BE USED
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Are only trained users operating all tools and equipment
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Who is helping the untrained user to use the tools/equipment
Job Hazards or Risks - Identify Hazards (ie trips or fall hazards)
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Identified Hazard
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Initial Risk Assessment (L, M, H)
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Controls you can put in place
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Level of Control (Minimise or Eliminate)
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Residual Risk
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Controls you can put in place?
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Level of control
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Residual Risk
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Controls you can put in place
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Level of control
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Residual Risk
General Feedback
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Any Feedback from the team
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Feedback