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: __________________, __________________, __________________ |
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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 |
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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: __________________, __________________, __________________ |
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Expected Start Time: __________________
Expected Stop Time: __________________ |
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Any visitors expected at the location’
Name/s: __________________, __________________, __________________ Contact info: __________________, __________________, _________________ |
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Yes | No | NA | PPE and Equipment |
List PPE required and on site:
__________________ |
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Necessary tools on site and in good condition.
__________________ |
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Vehicle and equipment inspected and in safe working condition. |
Supervisor: ___________________________________________
Worker: ____________________________________________
Date: _________________________________________________