REACTIVE/REPAIR

JOB TICKET C1034

DATE JOB REFERENCE

CONTACT INFORMATION

Site Name Address

Supervisor CAR ID
Contact Telephone Contact Mobile
Target Completion Email
Priority Code Response Due By
Operative Sub-Contractor

Work Order Start Time 12:29

Work Instruction
Description of Works for Operative to complete

Appointment instructions

NIW Addition Information from Requestor Yes/No Notes

Are there any specific H&S requirements to be aware of?
Is there any requirements to meet in NIW staff on site on arrival
Is this site fitted with standard an NIW lock
 REACTIVE/REPAIR JOB TICKET C1034

OPERATIVE PRE-START RISK ASSESSMENT CHECKLIST Y/N/NA

Are you suitably trained to do this work (PASMA, IPAF, Gas Safe etc.)? Yes
Do you have the right tools and equipment for the job? & Are the tools calibrated or thoroughly inspected in
Yes
date?
Do you have the right documentation for the job (i.e RAMS, COSHH Data Sheets, Asbestos Register or
Yes
Building Surveys etc.)?
Are suitable welfare provisions on site or available to you for your use? Yes
Are all live systems isolated, where required? Yes

SPECIFIC PPE REQUIREMENTS – TICK THOSE NECESSARY

HEAD PROTECTION √ HIGH VIS √ BOOTS √ GLOVES
HARNESS/LANYARD EAR PROTECTION EYE PROTECTION DUST MASK

I confirm I have read and understand the task activity, risks associated, and controls measures to be
implemented and complied to SPECIFIC PPE REQUIREMENTS – TICK THOSE NECESSARY
√
Instructions: Prior to starting work, assess the area to identify any hazards and risks present, then tick Yes, No or Not
Applicable as appropriate. Where present, ensure that the control measures listed are in place and indicate. Sign and date
at the bottom.
Potential Hazards/Risks Y/N/NA Principal Control Measures to be put in place prior to starting Y/N/NA
Difficult access and egress Consider alternative routes; plan travel to minimize risks; wear
No NA
hard hat; all mandatory PPE; lighting
Restricted and/or confined Consider alternative workspaces; confined spaces to assessed
No NA
spaces by specialist; Training: specific RAMS
Slips, trips and falls Survey work area and access routes before start; board pits;
Yes Yes
wear safety boots; plan work accordingly
Work at height and access Specific assessment; use all safety features on access
equipment No equipment, i.e. guard rails, etc.; do not work within 2m of NA
unguarded fall hazard; isolate area below; specific RAMS
Asbestos containing materials Consult asbestos register and inspect work area; do not
No NA
approach or disturb;
Excessive noise No Use appropriate hearing defenders; minimize exposure time; NA
Manual handling No Minimise handling; use aids; use safety boots/gloves; NA
Underground Services Consult drawings if available; survey/ scan area; isolate, lock
No NA
off and tag: ensure correct permit is raised and comply
Lone working No Follow company lone working policy, procedures and training; NA
Hazardous substances Consult relevant COSHH Assessment and follow control
No NA
measures;
Use of hand and power tools Inspect before use; use only 110 volts; connect to RCD; wear
Yes Yes
safety boots/goggles; PAT tested
Hot works (welding, cutting Inspect equipment before use; ensure safety features are fitted
No NA
discs, etc.) and work; complete permit; all mandatory PPE
Fire and explosion Ensure fire emergency procedure is known; minimize ignition
No and fuel sources in work area; carry appropriate extinguisher NA
and alarm; keep access clear;
Dust Reduce dust generated or disturbed; wear dust masks; wash
No NA
after thoroughly;
Other (eg weather conditions)
Operative Name Operative Signature
Date of Assessment 18/05/2022 Date of Review 18/05/2022
I CONFIRM THAT I HAVE READ AND UNDERSTOOD THE RISK ASSESSMENTS AND METHOD
√
STATEMENTS ASSOCIATED TO THE JOB

Could Not Proceed – Seek Advice Safe to Proceed √

Details of Visit

PROBLEM
Please provide details of the reported problem or details of what works you are onsite to complete during this visit.
Doors have come away from frame due to erosion of hinges

BEFORE PHOTOS
Please provide photos below to support the above details.

CAUSE
Please provide details of what has caused the problem, if applicable or known.
Weather has caused hinges to rot away

SOLUTION
Please provide details of the work you have completed during this visit to resolve the problem. Even if the works are not
complete, please detail what you have done today.
New hinges tted and secured back onto frame
fi
AFTER PHOTOS
Please provide photos below to support the above details and demonstrate what works has been carried out during this visit.

MATERIALS/PARTS USED
Please provide details of all materials used during today’s visit:
SUPPLIERS PARTS REQUIRED/DESCRIPTION QTY
LBCE Boxes of hinges 4” ball bearing 3
7” bar bolt 1

Please answer the below: Y/N

Is this job now FULLY complete? Yes

FOLLOW ON WORKS:
If you have answered NO to the above question, please provide details below of what actions/work is still outstanding.
ADDITIONAL INFORMATION:
Please provide any further comments/details, eg. If you notice any other work on the site that you recommend being
completed.

ADDITIONAL INFORMATION – SUPPORTING PHOTOS:

Please provide photos below to support the above details.

Please Answer the Below: Y/N

Have you left the site in a safe and secure condition? Yes
Have you completed this job ticket to your satisfaction, and detailed everything carried out during today’s visit? Yes
Are there any amendments required to any H&S File or O&M Manuals on site? Yes

Notes:
Provide details if answered YES to bottom question above

SIGNATURE

Operative Signature Date 18/05/2022

Finish Time 15:32 Submit Your Form Works Complete

Lowry Building & Civil Engineering – The Old Bank, 7 John Street, Castlederg, BT81 7AW

028 8167 8646 info@lowrybuilding.co.uk