Items marked N/A are not required on every job. Tick only what is relevant to the work in front of you.
Contractor and work identification
| Done | N/A | Notes |
|---|
| Company name, registration number and contact | | — | |
| The contractor's site supervisor and contact details | | — | |
| Description of the work, its location and planned duration | | — | |
| The site's contact, and who approves the work | | — | |
| A list of the workers who will enter the site | | — | |
| Insurance certificates, where the site requires them | | | |
| Subcontractors — who they are and the extent of their work | | | |
Site rules
| Done | N/A | Notes |
|---|
| Permitted working hours and entry and exit procedures | | — | |
| Smoking prohibition and permitted areas | | — | |
| Prohibited or restricted areas, and how they are marked | | — | |
| Who to report a hazard, accident or near miss to | | — | |
| Stop-work authority — whose it is, and when it is used | | — | |
| Traffic, parking and vehicle route rules on site | | | |
| Order, cleanliness and waste clearance at the end of each day | | | |
Emergency arrangements
| Done | N/A | Notes |
|---|
| What the alarm sounds like and how to raise it | | — | |
| Escape routes from the work area and the assembly point | | — | |
| Where first aid equipment is and who is qualified to give it | | — | |
| The site's emergency numbers | | — | |
| Spill arrangements, and where the spill kit is | | | |
Personal protective equipment
| Done | N/A | Notes |
|---|
| The protective equipment required to enter the site | | — | |
| Additional equipment required for the specific work | | — | |
| The contractor supplies serviceable equipment, checked before entry | | — | |
| Respiratory protection, after matching to the type of exposure | | | |
| Hearing protection in areas where the noise level requires it | | | |
Work permits
| Done | N/A | Notes |
|---|
| Hot work permit — welding, cutting, grinding, heating | | | |
| Work at height — certification, equipment and anchor points | | | |
| Confined space entry — dedicated procedure, atmosphere testing and watch | | | |
| Energy isolation and lock-off before working on equipment | | | |
| Excavation — locating underground services before starting | | | |
| Lifting — in-date equipment and a certified operator | | | |
Site hazards
| Done | N/A | Notes |
|---|
| The specific hazards in the area where the work will be done | | — | |
| Hazardous materials in the area, and their safety data sheets | | | |
| Known sensitive materials on site and the limits on them | | | |
| Adjacent work that could interact | | | |
| Live systems in the area — gas, electricity, water, fire detection | | | |
Acknowledgement
| Done | N/A | Notes |
|---|
| The contractor and their workers were briefed and understood the above | | — | |
| Signature of the contractor's representative, name and date | | — | |
| Signature of the site's representative, name and date | | — | |
This material reflects Hoshen's professional practice. It is not legislation and establishes no legal duty. Adapt it to your site, your risks and the requirements that apply to you.