Title Page

  • Name

  • Location
  • Conducted on

  • Activity

Tick confirms this has been carried out

  • Has the van been checked to ensure that first aid kit is present and is well stocked?

  • Does the van have suitable spillage matts or granules present in case of fluid spillage?

  • Have all machines being used been checked and serviced as per manufactures recommendations? If machinery not working correctly or damaged please inform manager

  • Have the fuel cans being used been checked for any damage? If fuel can is damaged do not use and inform manager

  • Site Access

Tick the boxes which are applicable to the job prior to work starting. Ticking the box ensures you and the team have considered and understand the health and safety considerations associated with the site, the public and machines being used

  • Site Access

  • Welfare

  • Noise

  • Vibration

  • Traffic Management

  • Wildlife

  • Overhead Power lines

  • Signage

  • Roads/pathways

  • PPE required

  • Slopes/uneven ground

  • Fuel/Petrol/diesel/oil

  • Manual Handling

  • Herbicides

  • Tree Felling

  • Weather conditions

  • Chainsaws

  • Digger and attachment

  • MEWP

  • Tractors

  • Working near water

  • Dumper

  • Strimmer

  • Whacker plate

  • Winches/ropes/cables

  • Concreate breaker

  • Painting

  • Angle grinder

  • Ladders and step ladders

  • Cement mixer

  • Non powered hand tools

  • Generator

  • Litter picking

  • CAT &Genny

  • Fencing and repairs

  • Record Any Unexpected Hazards & Control Measures Applied, additional to the General Risk Assessment

Emergency Planning

  • Emergency Plan: (Dial 112)

  • What3Words Location

  • Acknowledged by all workers on site:
  • Signature

  • Date

Acknowledgment of changes to work site should be noted below (to be signed and dated by Supervisor each day of work including any changes to site)

  • Changes

  • Signature of Supervisor

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.