Site Safe Work Plan Business Services

Site Safe Work Plan – Business Services

Work leadername / Date (Yr/Mth/Day) /
Location (specific area of branch)
Brief description of work
Have you considered?(check off if applicable)
People / Procedures / Hardware/equipment / Environment
Person in charge / Written procedures / Inspection of equipment / Securing of fence/gates
Qualified/experience / Rescue procedures / Inspection of tools and PPE / Weather conditions
Other groups/contractors / Man working alone / Inspection of vehicles / Adjacent hazards
Communications / Fall protection / First aid equipment / Lighting conditions
First aiders available / Confined space / MSDS information / Workers above/below
Public safety / Lock-out / Fall arrest equipment / Housekeeping
Ergonomics/position / Other: / Safe loads for rigging / Noise/dust/mists
Crew complement / Other: / Physical barriers / Special waste
Previous injury/medical conditions / Other: / Hoisting/rigging / Spill procedure
Rushing / Other: / Stock secured on rack / Spill kit
Frustration / Other: / Vehicle pre-trip / Driving conditions
Fatigue / Other: / Cribbing / Other:
Complacency / Other: / Other: / Other:
Other: / Other: / Other: / Other:
Other: / Other: / Other: / Other:
Major hazard identification (check off if applicable)
The four elements of PPE must be worn in any active work zone.
Gravity / Chemical / Mechanical/excavation / Kinetic vehicular / Electrical
Falling from heights / Toxic or poisonous / Equipment failure / Driving conditions / Overhead
Falling objects / Flammable explosive / Flying objects / Moving loads / Clearance
Other: / Asphyxiation / Tension loads / Vehicular stability / Other:
Other: / Corrosive / Moving parts / Vehicular conditions / Other:
Other: / Radiation / Pinch points / Traffic conditions / Other:
Other: / Bio-hazard / Heat / Other: / Other:
Other: / Other: / Pressure / Other: / Other:
Other: / Other: / Other: / Other: / Other:
List each significant job and ensure each identified hazard has a barrier described
Hazards / Control plan/barriers
Emergency response plan
Address / Muster station location
Emergency contacts
First aid: / Police/fire/ambulance : 911 / Aware of eye wash station location / Aware of fire extinguisher location
Contractors on site
Name / Working location / Discussed and aware of the hazards?
Sign off
This work plan has been discussed with team members. Initial as acknowledgement.
Monday / Tuesday / Wednesday / Thursday / Friday / Saturday
Changing conditions(this safe work plan expires in 7 days, any changing conditions must be discussed and reviewed)
Have any conditions changed?
No Yes / If yes, please describe and discuss with crew members, if major change, fill out new form with updated hazards.
Work leader initial:
Post action review (post job and safety comments)
Manager signature

3262 13/09