Do i clearly understand what if required?
Am i trained to do the work and familiar with the equipment/task?
Are the tools and equipment is safe condition?
If the task involves working with or near Hot Works, Working at Heights, or Excavation? Do you have the required permits? (Leave blank if no permits required)
Do i have the appropriate documents for the task?
Am i safe from other activities/ tasks in the area?
Have I informed others who may be affected by my works?
Are precautions in place to stop others entering my work space if necessary? (Barricades, signs, ect......)
Have I implemented appropriate traffic management? (Leave blank if not required)
Do I have the correct PPE for the task?
If you answered "YES" to all of the above, all attending site to sign below and proceed with works,
***IF "NO" to any, take action to correct & complete below
risk rating? (Before Control)
risk rating? (After control)
Risk Rating? (Before Control)
Risk Rating? (after Control)
Are there any other risks you can think of?
Are all the risks adequately controlled?
Have all the hazard controls been implemented?
Have all potential problems been discussed and understood by all?
Can the task proceed safely?
If "NO" to any, do not proceed and complete a JSA/SWMS.
Any other staff?