Safety, Health and Environment Management System

Forms: Safe Start Form

Function of form: This form is to be completed each day
Site Address
Supervisor on Site
Date
Ensure that each day is signed. The list of areas below are to be checked on each daily shift. If all is safe and where appropriate is in place work can then proceed. If the work is unsafe then work cannot start until it is safe to do so.
Areas to discuss with personnel Not applicable All safe & in place Not safe Comment
Scaffolding if used is visually safe to use
Harnesses are visually inspected before use and safe to use
All personnel are wearing PPE - safety shoes, high vis, gloves, ear and eye protection (where appropriate), hard hat, mask
All job site specific hazards discussed with operatives
Ladders are safe to use - visual inspection done before use
Personnel have not reported being sick or feeling unwell
Welfare facilities available - toilets, water
Tools are safe to use
Mobile phones not to be used whilst working. To be used only on breaks and in an emergency
Dust mask & eye protection used when working in dusty enviromnents
Good housekeeping measures discussed
No eating, drinking or smoking allowed discussed
Due care and attention discussed
Only retractable blades to be used
Dust sheets used where required
Tools tethered when working at height
Only trained operators to use MEWPS & other plant
Personnel aware to report near miss & incidents immediately
First Aid & Eye wash access discussed
Toolbox talk completed weekly
All portable equipment PAT tested
Environmental issues such as waste removal discussed
Site fire evacuation discussed
Permit issued by site where required
No asbestos in area of work
Any other specific site requirements discussed
Name / Signature  
Click to sign
Email address