ENG - LAST-MINUTE RISK ANALYSIS

ENG - LAST-MINUTE RISK ANALYSIS
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
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?
Do I think the agreed measures are sufficient to work safely?
Do I have and will I wear the right personal protective equipment?
Do I have the right tools? Are these in good condition and inspected if necessary?
If work of others in my neighbourhood affects my task or visa versa: have we consulted?
Is my workplace easily accessible, sufficiently tidyand safe?
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.

Other
Take Photo
Take Photo
Take Photo
Take Photo
File Upload

Cancelof
File Upload

Cancelof
Name Teamleader

First NameLast Name
Signature Teamleader
Name

First NameLast Name
Signature
Name

First NameLast Name
Signature
Name

First NameLast Name
Signature
Should be Empty:

Measures taken effectively