Information

  • Client / Site

  • Conducted on

  • SITE ADDRESS AND AMBULANCE PICK UP POINT
  • NAMES OF WORKERS USED FOR THIS TASK

  • NAME OF SUPERVISOR / LEADING HAND FOR THIS TASK

  • NAME OF PERSON FILLING OUT THIS FORM

  • CHOOSE OPTION FOR TASK BEING CARRIED OUT.

  • ARE THERE ANY HAZARDS FOR REVIEW

  • ON A SCALE OF 1 - 10 (1 being no risk) RATE HAZARD HERE

  • IS THERE ANY MAINTENANCE NEEDED

  • TO BE COMPLETED FOR ALL WORK ON OUTDOOR ADVERTISING STRUCTURES. IF MORE THAN ONE SKIN IS TO BE INSTALLED AT A PARTICULAR SITE PLEASE TICK BOX HERE

  • HAS EVERYONE READ, SIGNED AND UNDERSTOOD THE SWMS FOR THIS TASK

  • CONSULT, READ AND SIGN SWMS IMMEDIATELY

  • IS WEATHER SUITABLE FOR SAFE INSTALLATION?

  • CAN USING EXTRA INSTALLERS ELIMINATE RISK

  • IF ANSWER IS NO CHOOSE MOST SUITABLE OPTION

  • DO YOU CONSIDER THE WORKPLACE IS SAFE TO WORK ON AND FROM

  • IF RESPONSE IS NO DO NOT INSTALL

  • INSERT PHOTO HERE

  • CAN SKIN BE TRANSPORTED TO SITE SAFELY

  • DO NOT INSTALL

  • IS THERE SAFE PARKING AND ACCESS TO SITE?

  • IF RESPONSE IS NO DO NOT INSTALL

  • INSERT PHOTO OF ACCESS HAZARD HERE

  • IS THE SITE COMPLETELY FREE FROM ELECTRICAL HAZARDS?

  • IF ANSWER IS NO CHOOSE BEST OPTION TO ELIMINATE RISK

  • INSERT ELECTRICAL HAZARD PHOTO HERE

FOR WORK WITH LADDERS

  • CAN YOU PLACE LADDER ON EVEN GROUND

  • IF ANSWER IS NO DO NOT INSTALL

  • DO YOU USE FALL PROTECTION DEVICES?

  • IF ANSWER IS NO DO NOT INSTALL

  • ARE THERE PERMANENT ANCHOR HOOKS OR STATIC LINES ON THE STRUCTURE?

  • IF ANSWER IS NO PLEASE CHOOSE THE SAFEST OPTION

  • CAN YOU MAINTAIN THREE POINTS OF ATTACHMENT AT ALL TIMES

  • IF THE ANSWER IS NO DO NOT INSTALL AND REPORT TO MANAGEMENT

FOR WORK WITH EWP

  • IS EWP OPERATOR LICENSED AND COMPETENT?

  • IF ANSWER IS NO DO NOT INSTALL AND REPORT TO MANAGEMENT

  • HAS EWP BEEN ASSESSED AND DEEMED SUITABLE FOR TASK?

  • IF ANSWER IS NO DO NOT INSTALL AND REPORT TO MANAGEMENT

  • IS EWP SETUP ON FIRM LEVEL GROUND?

  • IF ANSWER IS NO CHOOSE BEST OPTION

  • HAS EWP LOGBOOK BEEN FILLED OUT?

  • FILL OUT LOGBOOK IMMEDIATELY

FOR WORK ON RAILWAYS

  • DO ALL WORKERS HAVE TRACK ACCREDITATION?

  • IS AN EXEMPTION IN PLACE FOR UNACCREDITED WORKER?

  • IF UNACCREDITED WORKER DOES NOT HAVE A CURRENT EXEMPTION THEY MUST NOT ENTER RAIL RESERVE

  • IS WPW15 PRESENT AND BOOKED ONTO TRACK

  • IF ANSWER IS NO DO NOT ENTER RAIL RESERVE

FOR ABSEIL INSTALLS

  • HAVE ALL ABSEIL ANCHOR POINTS BEEN ASSESSED AS SUITABLE?

  • IF ANSWER IS NO DO NOT INSTALL AND REPORT TO MANAGEMENT

  • HAVE ALL ROPES BEEN ASSESSED AS SUITABLE?

  • IF ANSWER IS NO DO NOT INSTALL AND REPORT TO MANAGEMENT

  • HAVE ALL HARNESSES AND GEAR BEEN ASSESSED AS SUITABLE?

  • ARE ALL ABSEILERS FULLY TRAINED AND ASSESSED BY MANAGEMENT AS COMPETENT?

  • IF ANSWER IS NO DO NOT INSTALL

MAINTENANCE

  • CHOOSE TYPE OF MAINTENANCE NEEDED

  • OTHER MAINTENANCE

  • ENTER MAINTENANCE PHOTO HERE

INSTALLER SIGN OFF

  • ALL INSTALLERS TO SIGN OFF BELOW

  • INSTALLER 1

  • INSTALLER 2

  • INSTALLER 3

  • INSTALLER 4

  • INSTALLER 5

  • INSTALLER 6

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.