Use this form to complete a site-specific risk assessment before work begins. General Risk Assessment – DOMESTIC Sites This risk assessment must be completed before work begins and whenever there is a change to the site, activities, or working conditions. Identify any hazards present, record control measures in place, and note any actions taken. If a risk cannot be adequately controlled, do not proceed and escalate to a supervisor or manager. Answer all Yes / No questions accurately Add notes where prompted Upload photos where useful (optional) Sign off at the end to confirm accuracy This assessment forms part of the CSS Cleaning Services LLP Integrated Management System and supports health & safety, quality, and environmental compliance. Assessor Declaration: This assessment must be completed by the logged-in CSS Cleaning Services LLP staff member carrying out the work or supervising the task. Submissions are recorded against the assessor for accountability and audit purposes. Site DetailsComplete before starting work.Site Name*(Required) Site Address*(Required)118 Maple Drive, Chellaston. Derby. DE73 6RX. UK, United Kingdom (Great Britain)Client / Company (if applicable)*Assessment Type*(Required) Routine (Scheduled) Dynamic (On-Arrival) Non-Routine / Change-Related Assessment Date*(Required) Month Day Year Assessment Time*(Required) Hours : Minutes Assessor Name*(Required)Assessor Role*(Required)CleanerSupervisorManagerNumber of staff present (optional)*General Hazards (Tick & add notes where “Yes”)Slips / trips hazards present?*(Required) Yes No Controls / Notes (Slips/Trips)Safe access/egress available (entrances, stairs, corridors)?* Yes No Controls / Notes (Access/Egress)Poor lighting or reduced visibility?* Yes No Controls / Notes (Lighting)Electrical hazards present (damaged sockets, exposed wires, unsafe equipment)?* Yes No Controls / Notes (Electrical)Will lone working take place?* Yes No Controls / Notes (Lone Working)Working at height required (steps, ladders, reaching high areas)?* Yes No Controls / Notes (Height)Fire exits clear and known?* Yes No Controls / Notes (Fire Safety)Security issues (keys, alarm codes, restricted areas)?* Yes No Controls / Notes (Security)Manual Handling & EquipmentHeavy items or furniture movement required?* Yes No Controls / Notes (Manual Handling)Equipment safe and in good condition?* Yes No Controls / Notes (Equipment Issues)PPE Required for this site/task* Gloves Eye protection Face mask / respirator Safety footwear Apron / protective clothing Hearing protection (if applicable) Extra PPE Needed Additional PPE / instructions (optional)COSHH & ChemicalsWill chemicals be used on site?* Yes No Chemicals to be used / controlsCOSHH information available for products used?* Yes No Controls / Notes (COSHH missing / actions)Correct dilution and usage understood?* Yes No Controls / Notes (Dilution/Usage)Adequate ventilation available?* Yes No Controls / Notes (Ventilation)Domestic-Specific Risks (Add notes where required)Pets present on site?*(Required) Yes No Controls / Notes (Pets)Client health considerations disclosed (allergies, vulnerabilities)?*(Required) Yes No Controls / Notes (Client Health)Fragile or high-value items present?*(Required) Yes No Controls / Notes (Fragile Items)Restricted areas identified by client?*(Required) Yes No Controls / Notes (Restricted Areas)Client present during cleaning?*(Required) Yes No Controls / Notes (Client Presence)Children or vulnerable persons present?*(Required) Yes No Controls / Notes (Safeguarding)Parking / access restrictions affecting safe unloading?*(Required) Yes No Controls / Notes (Access / Parking)Additional domestic-specific hazards identified?*(Required) Yes No Controls / Notes (Other Domestic Risks)Photos (Evidence)Upload site photos (optional)* Drop files here or Select files Accepted file types: jpg, jpeg, png, webp, Max. file size: 10 MB, Max. files: 5. Actions / Controls & EscalationImmediate actions taken / controls applied*Is a supervisor required before work continues?*(Required) Yes No Supervisor Approval Required A higher-risk condition has been identified. Do not proceed until supervisor approval has been obtained. Tick the approval box below and record the supervisor name before submitting this assessment. Risk Rating*(Required) Low Medium High Escalation details / who was contacted*Supervisor Approval*(Required) Supervisor approval has been obtained and work is authorised to proceed. Supervisor Name*(Required)Supervisor Approval Method*(Required) On Site Approval Phone Call Message/WhatsApp Other Approval Notes (optional)*e.g. Supervisor attended site, controls agreed, PPE confirmedIs further review required (change of conditions / unresolved risks)?*(Required) Yes No Further Review Notes (optional)*Additional Notes (optional)*Declaration & Sign-OffDeclaration*(Required) I confirm that I am the logged-in CSS Cleaning Services LLP staff member completing this assessment and that any required supervisor approval has been obtained before work proceeds. Typed Name (Signature)*
