Working Alone Procedure

• Audit Title

• Conducted on

  Date

Hazard Assessment

• Date of Procedure

  Date

• Employee's Name

• Detail of Task and Location while Working Alone

• Potential Hazards Associated with Task

Control Methods

• Time of Working Alone Procedure Start

• Time of Working Alone Procedure End

• Phone Contact with Employee Shall be Every

• Phone Contact Shall be Initiated by

• A Record of Contact with Employee to be Documented on this Procedure

• Time

• Time

• Time

• Time

• Time

Emergency Procedure

• Both the Employee and Buddy Contact shall keep a copy of this procedure and ensure they are accessible at their stated phone number.

• If contact with the employee is not established at the agrees upon time, the buddy contact shall continuously try to phone the employee for TEN MINUTES.

• If no contact after ten minutes, the buddy contact shall immediately attend the location of the employee working alone to determine the worker's well being and to take appropriate control measures.

Implementation of the Procedure

• Both the employee and employer representative verify that each understand this procedure. Failure of either party to fulfill their responsibilities as stated shall be deemed in serious breech of company policy and violations will be dealt with accordingly.

• Employee

  Sign

• Employer Rep.

  Sign