This template can be utilised by team managers and safety officers to decrease risks before any accidents or injuries occur. It can assist you as a guide to do the following: List involved lone workers; Evaluate medical fitness, supervision method and training programs in place; Assess the whole location and premise; Recognize any risks present and assign actions to responsible teams; Record proof and findings by taking photos, attaching some notes and finish the report with a digital signature.
Share now
Digitalize this paper form now
Register for free on lumiformapp.com and conduct inspections via our mobile app
Supervision: What agreements do you have to keep in contact with the lone worker?
Medical Fitness:Does the loan worker have any medical condition that may put them at heightened risk when working separately?
Training & Competency: Is the lone worker qualified to do the work on his/her own?
Training & Competency : Has essential information, guidance, and training been provided to the lone worker?
Location & Premises
Emergencies: Does the lone worker have admission to emergency warning devices and methods to sound the alarm in event of an emergency e.g. fire alarm, motion sensors /manual device?
Access: Are there a secure means of entrance/egress for the lone worker?
Welfare facilities: Is there sufficient heating, lighting, access to drinking water and toilets?
Building security:Is the building safe and protected?
First aid:Are there arrangements to handle a situation where the lone worker gets ill or has an accident?
Process/Work Activity
Select risks or dangers observed in the workplace
Photo of the documentation (if necessary)
Completion
Name and signature of inspector:
Please note that this checklist template is a hypothetical example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
Please, finish the registration to access the content of the checklist.
