DD slash MM slash YYYY

Take 5

Any issues that require actions?

e.g. Safety/environmental hazards identified that are not covered by existing documentation
I, understand, acknowledge and accept that:
  1. 1. The safety uses work practices and precautions (including PPE) relevant to the above subjects/topics have been reviewed and explained to me.
  2. 2. The key points have been explained and are clearly understood by me.
  3. 3. I shall advise my supervisor of any individual needs in relation to carrying out the work safely.
  4. 4. I shall only carry out work for which I am equipped and competent.
  5. 5. I will comply with the ‘No Live Work Policy’ and relevant SWMS’, otherwise work must stop immediately.
  6. 6. I shall only commence work after undertaking hazard identification and risk assessment.
  7. 7. I will be vigilant regarding hazards and suitability of the HRA and SWMSs for the task at hand and implement further control measures where required.
  8. 8. I understand that I am authorized and expected to safely stop work and immediately notify my supervisor if a task carries and unacceptable level of risk.

Attendance Record

Pre-Start Checklist

Tick applicable box

COVID-19 Risk Management

Work Precaution Checklist
Clean hands regularly
Cover your nose & mouth when coughing/sneezing
Avoid touching your face, nose, mouth, hand shaking
Avoid close contact. Maintain social distancing 1.5 metres

Public & Visitor Safety

Work Precaution Checklist
Work areas signed / barricaded
Visitors to sign in “Visitors Book”
Visitors PPE required
Visitors escorted by inducted personnel

Prior To Any Works Starting

Work Precaution Checklist
Field report Risk Assessment completed
Control Measures implemented
Workers informed of hazards and PPE is worn
Workers accept control measures
Workers signed off on field report risk assessments
All workers equipment in test (tested & tagged) and Residual current device (RCD) in use

Working at Height (Above 2.0 Metres)

Work Precaution Checklist
Permit to work at height required
Inspected & maintained inertia reel required
Personnel working at height trained & competent for working at height
Area below the work clear of all personnel
Emergency rescue plan in place & recovery equipment available
Fall prevention / protection equipment in working order & personnel trained in use
Personnel working at height trained & competent for working at height

Electrical Work

Work Precaution Checklist
Electrical personnel certified & current
Isolations and lock out procedures required, Isolations proven, correct item de-energised and locked out. Capacitors discharged
Electrical leads elevated to eliminate trip hazards and not over extended
Live Work Form 20 and Procedures required
Testing by personnel required in accordance with Electrical Safety Act 2002
Test results recorded by personnel in accordance with Electrical Safety Act 2002
Signed test certificate (Field Report) required by personnel at completion of works in accordance with Electrical Safety Act 2002
Communications personnel certified & current
Signed Communications testing & certificate required

Major Plant, EWP, Kinetic (Moving Energy)

Work Precaution Checklist
Major plant & equipment certificate of operational compliance currency required
Operators certificate of training currency required
Work areas signed / barricaded, speed limits required
Audible & Visual warning required

Gravitational Work (Ladders & Scaffold)

Work Precaution Checklist
Work areas, passageways, stairs, doors, kept clear & barricades / signs required
Guard rails / mid rails to prevent fall into hazardous chemicals / substances / machinery or where fall could be in excess of 2.0m
Industrial rating ladders required
Correct size ladders required
Ladders used in excess of 2.0m high inertia reel & safety harness required
Works above 2.0m high performed on scaffold
Scaffolds erected by trained personnel
Scaffold certificate required
Extension ladder used for access only (not working from)

Manual Handling

Work Precaution Checklist
Risk assessment and work practice required
Repetitive lifting / carrying practice required
PPE required for lifting / carrying

Working in Ceiling Spaces

Work Precaution Checklist
Can the electrical services be isolated prior to entering
Adequate Lighting to perform work
Workers aware of all other services hazards present within veiling space
Correct ladders used for entering and exiting ceiling space

Can you see any other hazards?