Work Record Sheet and Risk Assessment (reactive)

• Client

• Site:

• Site location
  Address

• Description of work activity: (where, when, how, why, what,)

• Start date and time

  Date

• Work duration

  Select 1 day 2 days 3 days 4 days 5 days

  • 1 day
  • 2 days
  • 3 days
  • 4 days
  • 5 days

• Number of operatives:

  1

  2

  3

  4

  5 or more

• Prepared by (Supervisor)

Risk Assessment

• Asbestos

  Select YES NO N/a

  • YES
  • NO
  • N/a

• If YES has Asbestos Register / Survey and RIsk Assessment all been checked:

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Access and egress to work area

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Abrasive Wheels

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Brickwork / block work

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Flat roof work

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Slate / tile repair work

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Roof felting works

  Select YES NO N/a

  • YES
  • NO
  • N/a

• General roof work

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Concreting operations

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Use of Ladders or Stepladders

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Soft strip / Minor Demolition

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Mobile Scaffold Tower

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Mobile Elevated Work Platform

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Scaffolding

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Excavations

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Plastering or Rendering

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Plumbing

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Glazing

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Painting and Decorating

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Stairwells

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Suspended ceilings

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Work in public areas

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Lone Working

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Fire prevention

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Manual Handling

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Power Tools

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Noise

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Hand Tools

  Select YES NO N/a

  • YES
  • NO
  • N/a

Additional hazards and controls

• Note additional hazards and controls.

• Photographs of work area before work commences (if required)

  Media

Confirmation of RIsk Assessment checks and control measures

• Confirm risk assessments are checked

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Confirm the required control measures are in place

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Do you have the correct plant, tools and equipment to carry out the job?

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Are all the items of plant, tools and equipment checked and free from defects?

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Are ladders, scaffolds, mobile towers, stepladders and access equipment inspected and safe to use?

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Do they have the right PPE for the job?

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Have others on site been made aware of the required control measures?

  Select YES NO N/a

  • YES
  • NO
  • N/a

Names and SIgnatures of work team (confirmation of understanding of risk assessment)

• Supervisor

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

End of Job Review

• Has the area been handed back to the customer?

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Is the area in a clean and tidy condition?

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Has any hired plant been returned to the hirer?

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Has any waste been removed from site and if so where will it be transferred to?

  Select Head Office Transfer Station Site skip N/A

  • Head Office
  • Transfer Station
  • Site skip
  • N/A

• Is a return visit required?

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Confirm work completed safely and without incident / accident

  Select YES NO N/a

  • YES
  • NO
  • N/a

• Photograph of completed task (if required)

  Media

• Add signature

  Sign

• Select date

  Date