ENG - LAST-MINUTE RISK ANALYSIS

ENG - LAST-MINUTE RISK ANALYSIS
Date*

DayMonthYear
Date
Project Number*
Name Subcontractor*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do I know the work and have I understood my task?*

YESNONA
Do I think the agreed measures are sufficient to work safely?*

YESNONA
Do I have and will I wear the right personal protective equipment?*

YESNONA
Do I have the right tools? Are these in good condition and inspected if necessary?*

YESNONA
If work of others in my neighbourhood affects my task or visa versa: have we consulted?*

YESNONA
Is my workplace easily accessible, sufficiently tidyand safe?*

YESNONA
ATTENTION: You may start work only after answering all questions with YES or N/A. If you cannot take
sufficient measures yourself to carry out you work safely, consult your colleagues and/ or responsible
supervisor or plant manager.
Measures taken effectively

(to be filled in by teamleader)
Describe which measures were effectively taken on the site. Note why the proposed measures were not followed. Changes to the prescribed fall protection must be made in consultation with the PM and/or QHSE employee. For checking purposes, the team leader takes a photo of the installed protection.*

StellingSafety netRSS roof protectionHarnessLOTOTO (de-energise, lock and test installation)Additional PPE for electrical workOther
Take Photo*
Take Photo*
Take Photo
Take Photo
File Upload

Cancelof
File Upload

Cancelof
Name Teamleader*

First NameLast Name
Signature Teamleader*

Clear
Name

First NameLast Name
Signature

Clear
Name

First NameLast Name
Signature

Clear
Name

First NameLast Name
Signature

Clear
Should be Empty:

ENG - LAST-MINUTE RISK ANALYSIS

Measures taken effectively