Point of Work Risk Assessment (POWRA)

Point of Work Risk Assessment (POWRA)

Assigning of person in charge of safety (PICOS)
Project Name*
Project No.*
Date*

DayMonthYear
Date
Site Location*
What 3 Words (W3W)*
PICOS*

First NameLast Name
Completed by*

First NameLast Name
Signature*

Clear

Part 3 - Act
Please note any additional hazards identified:
Additional hazards
Mandatory - OverallsMandatory - Hi-VisMandatory - Safety BootsTask specific - Eye ProtectionTask specific - GlovesTask specific - Ear ProtectionTask specific - Hard HatTask specific - Face mask
Other items, as specified by Risk Assessment

Part 4 - Contacts
Working party register

All team members, and visitors to site must sign this register.
Name

First NameLast Name
Signature

Clear
Name

First NameLast Name
Signature

Clear
Name

First NameLast Name
Signature

Clear
Name

First NameLast Name
Signature

Clear
Name

First NameLast Name
Signature

Clear
Name

First NameLast Name
Signature

Clear
Name

First NameLast Name
Signature

Clear
Do not submit until the end of the activity and all parties have signed.
Should be Empty:

Part 1 - STOP