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Run: Working Alone Hazard Assessment

Use this Working Alone Hazard Assessment template to document site hazards, communication checks, and emergency readiness before a lone worker starts field w...

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Inspection Details

Work location and task are clearly identified

Document the site, route, or service area and the specific task to be performed.

Date and time of assessment recorded critical (required)

Assessment completed by competent person or supervisor critical (required)

Worker assigned to the task is identified critical (required)

Site Access and General Conditions

Access route is known and passable critical (required)

Yes No N/A

Work area has reliable cellular or radio coverage critical (required)

Yes No N/A

Weather and environmental conditions are suitable for safe field work critical (required)

Hazards from traffic, water, terrain, animals, or remote access are identified

Note (optional)

Lighting is adequate for safe access and egress critical (required)

Hazard Identification and Task Controls

Task-specific hazards have been identified critical (required)

Yes No N/A

Energy isolation or lockout-tagout requirements reviewed where applicable critical (required)

Yes No N/A

PPE requirements are defined and available critical (required)

Note (optional)

Controls for slips, trips, falls, and struck-by hazards are in place critical (required)

Yes No N/A

Heat, cold, or other environmental exposure is controlled

Communication and Check-In Plan

Primary communication method is available and tested critical (required)

Yes No N/A

Backup communication method is available critical (required)

Yes No N/A

Check-in frequency is defined critical (required)

Note (optional)

Emergency contact and escalation procedure are documented critical (required)

Yes No N/A

Worker can summon help without delay critical (required)

Emergency Readiness and Rescue

First aid supplies appropriate to the task are available critical (required)

Yes No N/A

Emergency response plan is understood by the worker critical (required)

Yes No N/A

Nearest medical facility or rendezvous point is identified critical (required)

Rescue or retrieval limitations have been considered critical (required)

Controls, Signoff, and Follow-Up

All identified deficiencies have corrective actions assigned critical (required)

Yes No N/A

Work may proceed under current controls critical (required)

Inspector signature critical (required)

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