Title Page
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Document No.
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Conducted on
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Prepared by
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Location
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Director Name
At risk behaviour evaluation
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PPE being used?
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PPE in good condition?
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Correct use of tools or equipment?
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Tool and equipment in good working order?
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Does the employee understand all his associated hazards and risks relating to the task?
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Has the employee been trained in performing this activity/task?
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Is adequate signage in place?
At risk conditions evaluation
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Housekeeping in the area?
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Is a sufficient Risk Assessment in place for the task/activity?
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Have they seen the Risk Assessment?
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Is the environment safe?
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Weekly coolant checks carried out?
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Pre Start check completed?
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Aware of the near miss reporting process?
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Have they raised an observation or near miss?
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Is an FLT used in the area?
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Has a Pre Start check been carried out on the FLT?
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Is the operative aware who the first aider is in the area?
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Is the first aid kit stocked adequately?
COSHH
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Are COSHH substances stored in a COSHH cabinet?
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Are chemicals stored in the correct containers?
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Are substances labelled up correctly? substance and date?
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Is the employee aware of the associated hazards symbols?
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Eating and drinking in the area, sealed container, for drink, no food permitted
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Chemical spill kit readily available in the area?
Management/Director commitment
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Will an action plan be required to rectify the issues?
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Director summary
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Approved by (Director)
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Approved by (HSE)
