Title Page
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Conducted on
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Conducted by
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Site Location
Site Checklist
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Have I thought about the task?
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Do I require a permit to do my work? (e.g. heights, confined spaces, hot work etc...)
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Do I have safe access/ egress?
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Am I using the right tools/ PPE for the task?
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Will my task impact anyone else?
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Have I communicated with other personnel in the area?
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Will I be working on an uneven surface?
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Can I slip or trip on anything?
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Are all hazardous energies controlled?
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Will any part of my body be in the line of fire?
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Will the task involve an awkward posture, forceful exertion, repetition, vibration, or excessive noise?
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Will I be working with or around chemicals/acid/caustic/biological materials?
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Will I interact with mobile equipment?
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Is there a chance I could harm the environment? (spill, pollute or damage)
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Are there any hazards? (above, below, behind, inside)
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Do I need to communicate the hazards associated with this task to others?
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If any of your answers are 'RED' - identify the hazard and it's controls in the next section.
Hazard and Risk Assessment
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What is the hazard?
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What is the risk rating for this hazard?
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Add photos (where applicable)
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What controls are being implemented?
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What is the revised risk rating for this hazard?
