Company Name

JOB SHEET AND SITE-SPECIFIC RISK ASSESSMENT

CLIENT NAME & CONTACT NO / ENQUIRY DATE / REFERENCE
SITE ADDRESS (inc. postcode): / INSPECTED BY:
DATE / NO OF MAN DAYS
JOB DESCRIPTION / SITE PLAN ATTACHED? / Yes / No
TREE No: / SPECIES / WORK REQUIRED:-
(JOB DESCRIPTION CONTINUED?): / Yes / No
TPO / CONSERVATION AREA? / Yes / No / PERMISSION GRANTED? / Yes / No
BATS / NESTING BIRDS? / Yes / No / FURTHER ACTION REQ.? / Yes / No
WAH ASSESSMENT / JUSTIFICATION: / Refer to ICOP – Tree work at height for assistance
All work from Ground Level
Temporary Access Platform
Work Positioning
DISPOSAL OF ARISINGS / SPECIFIC REQUIREMENTS:
EXTRA EQUIPMENT REQUIRED – IN ADDITION TO STANDARD ISSUE:
Large Saws / Winch
Brushcutter/Clearing saws / Traffic Control (Specify below)
Specialist Lowering Kit / Stump Grinder
Chipper / Hedge Trimmer
Chemicals / (Chemical data sheets available?) / Yes / No
OTHER EQUIPMENT
OPERATIVES COMPETENT TO USE EQUIPMENT ISSUED/CARRY OUT OPERATION SPECIFIED? / Yes / No

EMERGENCY CONTINGENCIES

Mobile Phone Signal Strength / Nearest A&E (inc. postcode) / Site postcode / Grid Reference
1 / 2 / 3 / 4 / 5
Site Access (4x4/helicopter) / Designated Rescuer / Name:
Rescue Plan / Write down a logical sequence of actions to recue with individual responsibilities and equipment required.

Risk Assessment continued overleaf/......


SITE-SPECIFIC RISK ASSESSMENT

List here the specific hazards/considerations of the site that pose a risk which needs to be controlled/ managed and then say how this will be achieved? (example below)

HAZARDS / CONTROLS
EXAMPLE passing pedestrians entering worksite being injured by falling branches / equipment etc. / EXAMPLE Worksite signed, coned & barriered to form exclusion zone. Ground staff to act as banksman / look outs.

Cont. on separate sheet if needed or develop further ‘generics’ for regular hazards/issues & add to list below

Generic Risk Assessments (insert references to all generic RA) / Relevant?
(√ or X)
EXAMPLE: Chain Saws (petrol driven)
Risk Assessment Completed by:
(Signed by Site Safety Co-ordinator) / Name:
Signature: / Date:
Operators on / visitors to site briefed. NAME / Signatures: to confirm briefing

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