Key Information

  • Description of Work:

Site Access

  • Have you got an STW induction card?

  • Card Number:

  • Do you have a valid copy of the customer authorisation for the task?

  • Do you have a copy of the customer safety rules handbook?

  • Are you aware of the closed gate policy?

  • Have you signed in/fobbed in/completed workbook?

Risk Assessments/Method Statements

  • Are the risk assessments/method statements in date?

  • Does the risk assessment cover all hazards where you are working?

  • Is the method statement being followed?

  • Are emergency arrangements in placw/understood?

  • Has a briefing taken place?

  • Has the method statement been signed?

  • Has a dynamic risk assessment been completed at the start of the task?


  • Do you know the mandatory PPE requirements for customer sites?

  • Are you aware of your responsibility under the PPE Regulations 1992?

  • Wearing hi vis polo shirt/vest (class 3) in good condition?

  • Wearing hard hat/bu,p cap in good condition?

  • Wearing appropriate footwear in good condition?

  • Wearing appropriate gloves in good condition?

  • Wet weather coat available and in good condition?

  • Hearing protection immediately available?

  • Eye protection immediately available?

Specialist PPE

  • Is a safety harness being used?

  • Is the harness in good condition?

  • Is the harness inspected/recorded?

  • Is the harness being used correctly?

  • Is a lanyard in use?

  • Is the lanyard in good condition?

  • Is the lanyard inspected/recorded?

  • Is the lanyard being used correctly?

  • Is a safety line in use?

  • Is the safety line in good condition?

  • Is the safety line inspected/recorded?

  • Is the safety line being used correctly?

  • Are waterproof suits being used?

  • Is the suit in good condition?

  • Are needle resistant gloves being worn?

  • Are the gloves in good condition?

  • Is respiratory apparatus being used?

  • Is the respirtory apparatus in good condition?

  • Is the respiratory apparatus in test?

  • Is the respiratory apparatus being used correctly?

  • Is a gas monitor being used?

  • Is the gas monitor calibrated?

  • Is the gas monitor being used correctly?

Vehicle and Plant

  • Do you have a CPC card available?

  • Do you have appropriate licences for the equipment being used?

  • Is the vehicle in good condition?

  • Do you have a defect book?/using r2c?

  • Have the defect sheets been completed?

  • Have any defects been logged?

  • List any defects highlighted:

  • Has a forward facing camera been fitted?

  • Is the forward facing camera in working condition?

  • Is the camera being used correctly?

  • Has the memory card been formatted?

  • Has the working area been considered for the vehicle/plant/operation?


  • Is a pink leptospirosis/clean water card available?

  • Are hand wipes/antibacterial gel available?

  • Do you have access to washroom/hand dispenser?

First Aid

  • Is a first aid kit available?

  • First Aid Kit Number:

  • Is the first aid kit in date?

  • Is the first aid kit complete?

  • Is the first aid kit stored in an appropriate place?

  • Are you aware that first aid training is available?

Isolation and LOTO

  • Are isolations in place for the task?

  • Are you aware of the LOTO procedure?

  • Are you trained in the isolation procedure?

  • Is a personal safety lock available?

  • Are all isolations locked and tagged?

Overhead Power Lines

  • Are there overhead power lines on site?

  • Are you aware of vehicle/equipment height when working near power lines?

  • Are signs/barriers/cones in use?

  • Are signs/cones/barriers in good condition?

  • Are goal posts in use?

  • Are you aware of the distances to keep equipment from overhead power lines? (15m)

Signage - Working on the Highway

  • Does traffic management apply?

  • Are suitable barriers/signs/cones in use?

  • Are the barriers/signs/cones in good condition?

  • Is the correct PPE being worn? (Class 3)

  • Have you completed streetworks training?

Working at Height

  • Are staff working at height?

  • Are you aware that you are working at height?

  • Is WAH the best solution for the task?

  • Have appropriate control measures been implemented for the task?

  • Are 3 points of contact maintained when entering/exiting a vehicle?

  • Are ladders being used?

  • Are the ladders in good condition?

  • Are the ladders inspected and recorded?

  • Is a scaffold being used?

  • Has the scaffold been erected by a severn trent approved supplier?

  • Is the scaffold inspected and in date?

  • Is a mobile elevated working platform (MEWP) being used?

  • Is the MEWP in test?

  • Is a copy of the certificate available?

  • Has training been undertaken to operate MEWP (provide evidence)

Working with Electrical Equipment

  • Is electrical equipment being used?

  • Have battery powered tools been considered?

  • Are 110v tools being used?

  • Are all electrical tools portable appliance tested?

  • Are electrical tools in good condition?

Confined Spaces

  • Does the task involve confined spaces?

  • Has the operative got in date qualifications?

  • Has the confined spaces been assessed?

  • Has appropriate signage been used?

  • Have all entry procedures been adhered to?

  • Has a rescue plan been arranged and communicated?

  • Are gas monitors being used?

  • Is fixed ventilation being used?

  • Has the fixed ventilation been inspected and in date?

  • Is the fixed ventilation in good condition and in working order?

  • Is portable ventilation being used?

  • Is the portable ventilation sufficient for the task?

  • Has the portable ventilation been inspected?

  • Is the portable ventilation in good condition and in working order?

  • Is breathing apparatus being used?

  • Is the breathing apparatus tested and in date?

  • Is the breathing apparatus in good condition and in working order?

  • Is the breathing apparatus being used correctly?

  • Are escape sets being used?

  • Are the escape sets inspected and in date?

  • Are the escape sets in good condition?


  • Are COSHH assessments available?

  • Are COSHH assessments in date?

  • Are there any containers available?

  • Are the containers correctly labelled?

  • Are substances stored correctly?

  • Is the correct PPE available for the substances?

  • Is a spill kit available?


  • Are you aware of what to do in an emergency?

  • Do you know how to report hazards/safe acts/accidents/near misses?

  • Are you lone working?

  • Is the lone working procedure being followed?

  • Are you working to the working time policy?

Work Environment

  • Have you undertaken any manual handling training?

  • Is the standard of housekeeping good in the work area?

  • Is the lighting for the work area adequate?

  • Is the ventilation for the work area adequate?

Lifting Equipment

  • Is lifting equipment being used?

  • Are thorough examination certificates available?

  • Is all lifting equipment tagged?

  • Has lifting equipment been inspected?

  • Is lifting equipment in good condition?

  • Is lifting equipment

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.