Safety, Health & Environment Section RISK ASSESSMENT FORM Risk Assessment For Assessment Undertaken By Assessment Reviewed Service / School: Name: Name: Date: Date: Location / Activity: Signed by Dean of School, Name: Head of Service or nominee: Call-out work for staff and Date: Date: contractors involving lone work List List groups List controls, or refer to safety procedures etc. Remaining Significant of people level of risk Hazards here who are at risk Unable to raise Lone worker Security Team will be notified by lone worker of alarm in event (contractor or arrival on site (Harrington Security Lodge) of the Low of an employee) location and nature of work they are undertaking. emergency or Means of communication will be established (land accident. line, radio, mobile) for welfare checks and raising the e.g. alarm in an emergency. Fire, spillage, Lone worker will be notified of all relevant emergency affected by procedures. fumes or toxic The lone worker must be physically fit enough to carry substances. out the work. None of the prohibited activities detailed in Section 4.0 of Procedural Guidance for Lone Working (FM SHE 011) will be undertaken.
Safety, Health & Environment Section RISK ASSESSMENT FORM Risk Assessment For Assessment Undertaken By Assessment Reviewed Service / School: Name: Name: Date: Date: Location / Activity: Signed by Dean of School, Head of Service or nominee: Name: Call-out work for staff and contractors involving lone work Date: Date: List Significant Hazards here List groups of people who are at risk List controls, or refer to safety procedures etc. Remaining level of risk Unable to raise alarm in event of an emergency or accident. e.g. Fire, spillage, affected by fumes or toxic substances. Lone worker (contractor or employee) Security Team will be notified by lone worker of arrival on site (Harrington Security Lodge) of the location and nature of work they are undertaking. Means of communication will be established (land line, radio, mobile) for welfare checks and raising the alarm in an emergency. Lone worker will be notified of all relevant emergency procedures. The lone worker must be physically fit enough to carry out the work. None of the prohibited activities detailed in Section 4.0 of Procedural Guidance for Lone Working (FM SHE 011) will be undertaken. Low
FM%20SHE%20011%20Lone%20Worker%20Guidance.docx