Client Name:
Address:
Tel:
Email:

Principal Designer (PD) Name:
Address:
Tel:
Email:

Principal Contractor (PC) Name:
Address:
Tel:
Email:
Other parties on site (list all subcontractors, consultants & designers):

Brief Description of the project.
Planned Start Date:	Planned Completion Date:
Communications Plan (ie. pre start meeting, weekly progress meetings, who to attend etc.)
Hazard Identification
Work At Height (WAH), including falls into excavations and the like.
Risk Present? Yes / No	Controls:
Collapse of excavations
Risk Present? Yes / No	Controls:
Collapse of structures
Risk Present? Yes / No	Controls:
Exposure to dusts
Risk Present? Yes / No	Controls:
Exposure to asbestos
Risk Present? Yes / No	Controls:
Activities or workers requiring supervision eg. young workers, visitors etc.
Risk Present? Yes / No	Controls:
Electricity
Risk Present? Yes / No	Controls:
Risks to members of the public, the client and other 3rd parties
Risk Present? Yes / No	Controls:
Other risks
Risk Present? Yes / No	Details & Controls: