HEALTH & SAFETY CHECK SHEET Company Name and Details Here Company Address Here Company Address Postcode

Job Sheet - to cover: Planned & actual work, Risks & Safe working methods applicable
Customer	[CUSTNAME]	Site contact	[SITECONTACT]
Site address	[SITEADD] [PCODE]	Location(s) on site	[LOCATIONS]
Priority level	[TXT1]	Contact Tel	[CONTACTTEL]
Job raised on	[TXT2]	Due date	[DUEDATE]
Customer ref	[TXT3]	Target completion	[TARGETDATE]
Job Number	[TXT4]	Lead Engineer/ Supervisor	[LEADENG]
Scope of planned works (in sequence):
[SCOPEOFWORK]
Risk assessments applicable to the expected works-numbers as highlighted within the engineers file:
[RISKASSESS]
Lead Engineer/Supervisor to note any additional risks or unexpected work circumstances (NOTE: if significant other risks are found the Engineer must seek advice from the office before proceeding) [NOTES]
Actual work carried out/Engineers report-with any variations noted: [WORK]

Time Card

Engineer(s)	Date	Travel (Hrs)	Time on site	Time off site	Miles	Completed
CUSTOMER DECLARATION: As the customer, I confirm that the work has been carried out to my satisfaction
SIGNED:	PRINTED NAME:	DATE:

Hazard Identification- the following may be or are present based on our knowledge of the work or the site circumstances:

Occupiers	[CB1]	Hazardous substances	[CB6]	Manual handling	[CB11]	Slips trips & falls	[CB16]
Public	[CB2]	Asbestos	[CB7]	Lifting operations	[CB12]	Highway works	[CB17]
Work at height	[CB3]	Fragile roof surfaces	[CB8]	Flammable gases	[CB13]	Security	[CB18]
Heat	[CB4]	Pressure systems	[CB9]	Electricity	[CB14]	Traffic movement	[CB19]
Noise	[CB5]	Confined spaces	[CB10]	Below ground	[CB15]	Other-list below	[CB20]
Other hazards to be noted below with safe working methods described ( if applicable):
[OTHERHAZARDS]
Materials to be used: [MATERIALS] Storage & Delivery notes: [STORAGE]
Tools, Plant & equipment required: [TOOLS]
Protective equipment to be used:
Hard hat	[CB21]	Ear protection	[CB24]	Knee pads	[CB27]
Gloves	[CB22]	Goggles	[CB25]	Harness	[CB28]
FFP3 mask	[CB23]	Hi Viz	[CB26]	Coverall	[CB29]
Site specific emergency arrangements:
Emergency escape plan	[ESCAPEPLAN]	First Aid	[FIRSTAID]
Welfare facilities	[WELFARE]	Site Rules	[SITERULES]
Permit to work required?
Hot works	[CB30]	Services	[CB31]
Work at height	[CB32]	Confined spaces	[CB33]
Approved Sub-Contractors to be used- supervised by our own Management: YES / NO
Names & Trade (as applicable): [NAMETRADE]
Waste arrangements: [WASTE]
Lead Engineer/ Supervisor approval to proceed: I confirm that the relevant Risk, Safety, Emergency & protection arrangements are in place. It is now safe to carry out the works without the need to sign or approve any additional risk control measures Signed: Signature from Staff Members Date: [SIGNDATE]