Start Time
Expected End Time

If expected duration is greater than 2 hours a check-in is required every 2 hours.

Hazard Inspection

Identify all hazard that may be encountered during the working alone period




Is the hazard control in place?

Check-in Records

Worker will check in with designated contact at minimum every 2 hours and at end of working alone period



Select date

Has the working alone period ended?

In the event the worker does not establish contact, the designated contact will try to establish contact with the worker (communication device). If unable to do so the designated contact will contact emergency services.

Designated contact must not enter a confined space, or work area where the hazard has not been identified and controlled.

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.