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Safety Checklist for Lone Workers Working Alone
SAFETY CHECKLIST FOR LONE WORKERS WORKING ALONE

Instructions: Complete this Checklist before assigning a worker to work alone in a dangerous or isolated situation.

Yes No NA Risk Identification and Control
Full name/address of location and nearest emergency services.

Address:

__________________
__________________
__________________

Emergency services: __________________, __________________, __________________

Is there safe access in and out of the work site’
Risk assessment completed and hazards (both present and possible) identified for the job/task and the environment/location.
Does work involve:

[ ] Use of hazardous substances

[ ] Working at heights

[ ] Manual materials handling

[ ] Radiation or lasers

[ ] Gas, electricity, water

[ ] Moving parts

[ ] Sharps, needles, power/hand tools

Clear instructions of job/task to be completed.
Instructions and discussion of hazards and how to eliminate, minimize, protect against.
Security procedures specific to location discussed.
Lone worker has received first aid training.
First aid kit stocked and available.
Yes No NA Communication and Monitoring
Overall physical and mental state of worker is such that they can safely perform their job. (cold, headache, any meds being taken ‘ both OTC and RX, etc.)
Communication methods established, explained, and operational.
Check-in times established and agreed upon by supervisor and employee.
Monitoring device, if provided, fully charged/functional and on worker.
Worker knows who to contact in an emergency (aside from emergency services).

Name/s: __________________, __________________, __________________

Contact info: __________________, __________________, __________________

Expected Start Time: __________________

Expected Stop Time: __________________

Any visitors expected at the location’

Name/s: __________________, __________________, __________________

Contact info: __________________, __________________, _________________

Yes No NA PPE and Equipment
List PPE required and on site:

__________________
__________________
__________________

Necessary tools on site and in good condition.

__________________
__________________
__________________

Vehicle and equipment inspected and in safe working condition.

Supervisor: ___________________________________________
Worker: ____________________________________________
Date: _________________________________________________