Tyco Hazard Identification vASR 1

• Site

• Contract Number

• Task Description

• Conducted on

  Date

• Completed by

• Location
  Address

Revision Information

• This is electronic issue ASR 1 issued on 27/11/18

Personal Checks

• Do I clearly understand the task?

  Yes

  No

• Stop and contact your supervisor / line manager

• Record actions agreed with line manager or confirm actions put in place to reduce/mitigate risk identified

• Am I authorised & trained to carry out the task?

  Yes

  No

• Stop and contact your supervisor / line manager

• Record actions agreed with line manager or confirm actions put in place to reduce/mitigate risk identified

• Do I understand the risk assessment?

  Yes

  No

• Stop and contact your supervisor / line manager

• Record actions agreed with line manager or confirm actions put in place to reduce/mitigate risk identified

• Do I understand the the Safety Document and does it cover all the work on the work instruction?

  Yes

  No

• Stop and contact your supervisor / line manager

• Record actions agreed with line manager or confirm actions put in place to reduce/mitigate risk identified

• Are PPE and tools correct to perform the task?

  Yes

  No

• Stop and contact your supervisor / line manager

• Record actions agreed with line manager or confirm actions put in place to reduce/mitigate risk identified

• Is the task the same as the last assessment or as detailed on the SSOW form

  Yes

  No

• Stop and contact your supervisor / line manager

• Record actions agreed with line manager or confirm actions put in place to reduce/mitigate risk identified

• Is there any asbestos identified on the SSOW?

  Yes.

  No

• Have you reviewed the asbestos register?

  Yes

  No

• Will your work disturb any areas that have been identified as containing asbestos?

  Yes.

  No

• Proceed with caution.

• Stop and contact your supervisor / line manager

• Record actions agreed with line manager or confirm actions put in place to reduce/mitigate risk identified

• Is the asbestos register available?

  Yes

  No

• Please review the asbestos register before proceeding

• I confirm that I have reviewed the asbestos register

• Stop and contact your supervisor / line manager

• Record actions agreed with line manager or confirm actions put in place to reduce/mitigate risk identified

• Is the work area the same as the last assessment or as detailed on the SSOW form

  Yes

  No

• Stop and contact your supervisor / line manager

• Record actions agreed with line manager or confirm actions put in place to reduce/mitigate risk identified

• Do I understand the the method statement/procedure?

  Yes

  No

• Stop and contact your supervisor / line manager

• Record actions agreed with line manager or confirm actions put in place to reduce/mitigate risk identified

Personal Controls

• Am I working at height?

  Yes

  No.

• Do I have any concerns about working at height?

  Yes.

  No

• Stop and do a pre-work assessment and contact your supervisor / line manager where necessary

• A pre-work assessment has been completed

• Please contact your line manager or safety representative to discuss your concerns

• Am I working in a confined space?

  Yes

  No.

• Stop and do a pre-work assessment and contact your supervisor / line manager where necessary

• A pre-work assessment has been completed

• Am I doing hot work?

  Yes

  No.

• Stop and do a pre-work assessment and contact your supervisor / line manager where necessary

• A pre-work assessment has been completed

• Will carrying out my task adversely affect others?<br>

  Yes

  No.

• Stop and do a pre-work assessment and contact your supervisor / line manager where necessary

• A pre-work assessment has been completed

• Is there safe access & egress to work the location?

  Yes

  No

• Stop and contact your supervisor / line manager

• Am I working in a noisy environment?

  Yes

  No.

• Stop and do a pre-work assessment and contact your supervisor / line manager where necessary

• A pre-work assessment has been completed

• Will my work impact on others in the area?

  Yes

  No.

• Stop and do a pre-work assessment and contact your supervisor / line manager where necessary

• A pre-work assessment has been completed

• Have correct signs & notices been posted to warn others entering the area of my work?

  Yes.

  No.

• Please ensure that all required signs and notices are put in place before starting work

• All required signs and notices are now in place

• Have all the hazards been identified & evaluated?

  Yes.

  No.

• Stop and do a pre-work assessment and contact your supervisor / line manager where necessary

• A pre-work assessment has been completed

STOP, THINK, ACT, REVIEW

Additional Hazards

• Please detail any additional hazards identified

Additional Precautions to Be Taken

• Please detail any additional precautions to be taken

Equipment

• Please indicate all equipment being used

  Select Goggles Dust Suit Gloves Torch Hearing Protection Dust Mask Barrow/Trolley Lifting Bag Safety Harness Additional Lighting Safety Barriers Visor Waste Control Radio Fire Extinguisher Bolt Box Knee Pads

  • Goggles
  • Dust Suit
  • Gloves
  • Torch
  • Hearing Protection
  • Dust Mask
  • Barrow/Trolley
  • Lifting Bag
  • Safety Harness
  • Additional Lighting
  • Safety Barriers
  • Visor
  • Waste Control
  • Radio
  • Fire Extinguisher
  • Bolt Box
  • Knee Pads

Other PPE & Safe Working Equipment Required

• Please detail any other PPE & safe working equipment required

Sign Off

• Add signature

  Sign

• Supervisors Name

• Company