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Site Name

Daily On-site Checklist, Risk Assessment and Attendance Date

Sign (Risk

.
Assessor

Hazards

Currently

on site:

What

Can Be Done

To Ensure

Safety/Can

It Be Fixed/Yes/No?

Supervisor)

By signing this document I acknowledge that:

quality rules, instructions and procedure.

1. The risk assessment was discussed with me and I am aware of all dangers on site.

2. I agree to obey all safety, health, environmental and 4. I will not perform any tasks outside my

3. My PPE has been inspected and is in good working condition and I am aware of the limitations there of.

scope of work, or beyond that for which I am trained for.

5. I will report all incidents, accidents and near misses to the Site Supervisor before leaving site.

@
I also acknowledge that I will follow the Absolute Rules.
Persons Attendin ~ Onsite Risk Assessment

e0
.'
Was Inspected? Ex. Tools
J,

~
Your task: Fire Fighter/First aider/supervisor/other

Visitors

/ What

/ PPE /Harness/

Time
~_

Name

Company

in

out

A~

.'ik
OK/
Secured
1....)

~~~~

SUP / Visitor Other /What is your role on site. Signature Comments: User/ Visitor Signature Supervisor

Toolbox

Talk

/ Safety

Topic

Discussed

Evacuation

Point:

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Site Name

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Daily On-site Checklist, Risk Assessment and Attendance Date

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