Title Page
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Project Name
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Location
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Outline of Proposed Works
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Work Commencement Date
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Work Completion Date
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Site Supervisor Name and Contact Details
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Details of Subcontractors Involved in the Works Name(s) and Contact Details
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Plan Prepared By
Arrangements
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Are there specific site access arrangements ?
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Site Access Arrangements
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Are there specific arrangements for parking ?
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Parking Details
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Is there a specific site contact for reporting arrivals, departures, accidents and other site related issues ?
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Reporting Arrangements Arrival/Departure/Accidents/Issues
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Are there arrangements in place for a site induction ?
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Details of Site Induction Requirements (Including basic walk-through if that is all required)
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Are there specific site security arrangements ?
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Site Security Arrangements
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Are there arrangements in place for staff welfare, including toilets, washing facilities, first aid etc.?
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Welfare Arrangements Toilets/Washing Facilities/First Aid/Other
Minimum PPE Requirements
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Safety Boots
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Safety Goggles
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Gloves
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Dust Masks
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Details of any Other Required PPE
Key Risks
Asbestos
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Has the site Asbestos log been viewed ?
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Is the Asbestos log up to date ?
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Comments.
Working at Height
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Will the project include a requirement to work at height ?
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Details of Height Access equipment to be used.
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Details of users/certification
Other Risks
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Is there a risk from Electrocution ?
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If 'Yes' to the above, provide outline of controls in place / to be applied.
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Is there a risk from any type of gas ?
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If 'Yes' to the above, provide details of controls.
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Is there a risk from any type of dust ?
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If 'Yes' to the above, provide details of controls.
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Does the project include personnel going into any kind of confined space ?
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If 'Yes' to the above, provide details of the controls.
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Are the public or other site users being kept safe and not at risk ?
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If 'Yes' to the above, provide details of controls.
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Are there any other significant risks not covered by the above ?
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Please detail any other significant risk not covered by the above.
On Site Pre-start Checks
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Name of person completing this section
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Have you notified your office that you are on site ?
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Are the risks on site FULLY reflected in the previous sections ?
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Has suitable and sufficient PPE been provided and is it being worn ?
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Have you undertaken all of the requirements in the Arrangements section ?
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Note: If any of the above questions in this section can not be answered 'Yes', work must not commence until such times as action has been taken to rectify the issue.
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In the event that there is a significant change to the site conditions, layout or the project itself, this section must be re-done. Check the box to confirm that you understand the contents of the whole document, then add your signature below.
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Signature