SCC Health and Safety Manual

Risk assessment form: Working Alone Safely HS F09

Risk assessment form : Working Alone Safely

Please see HS 004 for guidance on how to perform a risk assessment, including details about how to calculate a risk rating (see the right-hand column of the table below). The SCC policy on Working Alone Safely is at HS 009. Situation / task / procedure or workplace being assessed: Names of assessors: Date:

Service or Group

Ref:

Issues to consider

Record your findings

What (if anything) are you already doing to control the risks?

Risk rating What further action is if applicable necessary?

(Severity x Likelihood) (Write complete details in Action Plan)

Is the workplace isolated from routine contact with other people? If yes, is this a problem? Could there be a problem getting in or out of the workplace?

Are there any hazardous substances or equipment involved in the task? Is equipment maintained? Is there a risk of violence? Has the
Issued by: Issue date:

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Risk assessment form: Working Alone Safely HS F09

Issues to consider

Record your findings

What (if anything) are you already doing to control the risks?

Risk rating What further action is if applicable necessary?

(Severity x Likelihood) (Write complete details in Action Plan)

lone worker received any personal safety training? Are women or young workers especially at risk if they work alone?

Is the lone workers personal health and fitness an issue? If so, what about their reaction to an emergency? Is first aid managed appropriately? Does the lone worker need training in first aid? Are communication arrangements between the worker and office a concern? Can the worker summon help? Does there need to be a failsafe system in the event of no communication? If there are local emergency procedures, are these known and understood by the employee? Does the lone worker fully understand the risk involved in the work and the precautions to be
Issued by: Issue date:

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Risk assessment form: Working Alone Safely HS F09

Issues to consider

Record your findings

What (if anything) are you already doing to control the risks?

Risk rating What further action is if applicable necessary?

(Severity x Likelihood) (Write complete details in Action Plan)

taken? Has he/she received training as required? Can a single person complete the task safely and efficiently? Any other comments or control measures not considered above?

Assessor signature:

Print name:

Review date:

You must get the approval of : your Group Manager for any MEDIUM risks, your Corporate Director for any HIGH risks.

Medium risks: Group Manager signature: Print name:

High risks: Corp Director signature: Print name:

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Risk assessment form: Working Alone Safely HS F09

Risk Assessment Action Plan

Action Plan in respect of: Prepared by: Ref no. 1 Action to be taken, incl. Cost By whom Target date Review date Outcome at review date

Responsible managers signature:

Responsible managers signature:

Print name:

Date:

Print name:

Date

Issued by: Issue date:

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