Work order number

Permit number

Site location


Date and time

Site Name

Risk Assessment
Traffic management

Designated Assembly Area in case of emergency

Services and Utilities/Overhead or Underground
Ground and Terrain conditions
Flora and Fauna protection
Noise and Dust
Spills and Leaks
Manual Handling
Mechanical Hazards

Other Hazards (please document)

Daily works report and observations

Herbicide Used
Equipment Used
Equipment used
Supervisors and field crew
Start time
Supervisors name
Bush crew member 1
Bush crew member 2
Bush crew member 3
Finish time
This is a true and accurate record.
Date and time

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.