LumiformMobile audits & inspections
Get AppGet App

Lone Working Risk Assessment Template

Rated 4.8/5 stars on Capterra

Say goodbye to paper checklists!

Lumiform enables you to conduct digital inspections via app easier than ever before
  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 5,000 expert-proofed templates
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 and conduct inspections via our mobile app

  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 4000 expert-proofed templates
Rated 4.8/5 stars on Capterra
App StorePlay Store

Lone Working Risk Assessment Template

Involved lone worker's name and position:


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)


Name and signature of inspector: