Are there any specific risks, eg working with:
Hazardous substances
Dangerous tools
Dangerous machinery
Dangerous loads or animals
If so, give a brief description
Are there parts of your establishment where different levels of risk can be identified (eg in a University with research laboratories)?
If Yes, give a brief description of the various work areas
What is your record of accidents and cases of ill health? What type are they and where did they happen?
How many people are employed onsite?
1-10
11-25
26-50
51-100
101+
Are there inexperienced workers on site, or employees with disabilities or special health problems?
Yes
If Yes, give a brief description
Are the premises spread out, eg are there several buildings on the site or multi-floor buildings?
Yes
If Yes, give a brief description
Is there shiftwork or out-of-hours working?
Yes
If Yes, give a brief description
Is your workplace remote from emergency medical services?
Yes
If Yes, how far is it to the nearest A&E?
1 to 3 miles
3 to 6 miles
7 to 10 miles
11 to 14 miles
15 to 20 miles
21 or more miles
Do you have employees who travel a lot or work alone?
Yes
If Yes, how many
1-10
11-25
26-50
51-100
101+
Do any of your employees work at sites occupied by other employers?
Yes
If Yes, give a brief description
Do you have any work experience trainees?
Yes
If Yes, give a brief description
Do members of the public visit your premises?
Yes
If Yes, give a brief description
Title:
Name:
Email address:
Telephone number:
