Title Page

  • Name

  • Date

  • Location/Task

  • Address

Assessment

Focus on critical risks

  • 1. Am I working with electricity?

  • SHEWMS Ref: Note the applicable SHEWMS you are working off and ensure you have been inducted into that SHEWMS, understand it's content and signed in.

  • 2. Is there a risk I could fall from one level to another?

  • SHEWMS Ref: Note the applicable SHEWMS you are working off and ensure you have been inducted into that SHEWMS, understand it's content and signed in.

  • 3. Am I working around live services?

  • SHEWMS Ref: Note the applicable SHEWMS you are working off and ensure you have been inducted into that SHEWMS, understand it's content and signed in.

  • 4. Am I completing excavation works or working in excavations or trenches greater than 1.5m?

  • SHEWMS Ref: Note the applicable SHEWMS you are working off and ensure you have been inducted into that SHEWMS, understand it's content and signed in.

  • 5. Am I working near live traffic?

  • SHEWMS Ref: Note the applicable SHEWMS you are working off and ensure you have been inducted into that SHEWMS, understand it's content and signed in.

  • 6. Am I working in and around an area of operating mobile plant?

  • SHEWMS Ref: Note the applicable SHEWMS you are working off and ensure you have been inducted into that SHEWMS, understand it's content and signed in.

  • 7. Am I working in a remote or isolated location?

  • SHEWMS Ref: Note the applicable SHEWMS you are working off and ensure you have been inducted into that SHEWMS, understand it's content and signed in.

  • 8. Am I performing heavy lifting using a crane or other mechanical lifting device?

  • SHEWMS Ref: Note the applicable SHEWMS you are working off and ensure you have been inducted into that SHEWMS, understand it's content and signed in.

  • 9. Could I be exposed to asbestos?

  • SHEWMS Ref: Note the applicable SHEWMS you are working off and ensure you have been inducted into that SHEWMS, understand it's content and signed in.

  • 10. Am I working in a confined space?

  • SHEWMS Ref: Note the applicable SHEWMS you are working off and ensure you have been inducted into that SHEWMS, understand it's content and signed in.

  • 11. Am I working on or near hazardous energies?

  • SHEWMS Ref: Note the applicable SHEWMS you are working off and ensure you have been inducted into that SHEWMS, understand it's content and signed in.

  • Identify your hazards (including critical risks above), assess your risk and note your controls.

  • Hazard
  • Specify hazard

  • Controls

  • Risk Rating

Completion

  • Additional comments

  • Have I achieved an acceptable risk rating and do I feel safe?

  • Stop work and contact your supervisor.

  • Sign off

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.