🧍‍♂️Lone Working Risk Assessment Form

📝Purpose

This form must be completed by all employees who are required to work alone in the community, in client homes, in clinic settings, or remotely. The assessment helps identify potential risks, mitigation strategies, and ensures that safety protocols are in place.

👤Employee Information

Full Name

Job Title/Role

Work Base/Area

Date of Completion

🔍Section 1: Lone Working Activities

Will you regularly be working alone without direct supervision?

Will you visit client homes or community settings alone?

Will you be working outside of normal hours (evenings/weekends)?

Will you be using your own vehicle to travel alone?

Is there mobile phone signal in your usual work areas?

Are there risks associated with the location (e.g. unfamiliar areas, poor lighting, unsafe neighbourhoods)?

Have any clients you visit alone been identified as high risk?

⚠️Section 2: Risk Mitigation Measures

Safety Measures (tick all that are in place)

Lone working training completed

Mobile phone fully charged and operational

Work schedule shared with line manager / team

Emergency contact protocol in place

Access to incident reporting procedure

Known client risks reviewed and risk-managed

Vehicle declaration submitted (if using own vehicle)

Personal safety equipment (if applicable) provided

🗣️Section 3: Additional Comments or Risks Identified

Please list any specific concerns, risks, or additional safety measures

✍️Employee Declaration

Signature

Clear

Date