Get documents about "Working Alone Checklist
Document Sample
29.1 WORKING ALONE CHECKLIST
Name of Designated contact: __________________________________________________________
Contact number: _________(______)_________-__________________________
Name of Employee who will be working alone: ____________________________________________
Employee contact number: _____(_______)__________-____________________
Emergency contact numbers: _______(______)________-_______________________________
_______(______)________-_______________________________
Mutual Aid number/s: ________(______)________-_______________________________
Date; ______/________/________
Job tasks that will be done: ___________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
What method will be used to check on the employee that will be working alone?
Visual Radio/Cell Emergency call signal
At what time intervals will the employee be contacted.
5min 10min 15min 20min
yes no n/a
Has a hazard assessment been completed on this task?
Is the employee trained in the working alone procedure?
Has the designated contact person been trained in the Working Alone
procedure?
Is the employee aware of the risks that are associated with doing this
job task alone?
Has this employee or other employees been involved in the development
of this "Working Alone Procedure"?
Has an equipment safety inspection been completed prior to operating
the equipment alone?
Have all items that do not meet manufacturers specifications been
corrected prior to operating the equipment alone?
Is there an emergency stop switch on the piece of
equipment to be used?
Scheduled Check times;
: : :
: : :
: : :
