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Safety6 min read

LMRA form: an example with questions you can use right away

An LMRA form is a short checklist that you fill in on the work site itself, just before the work starts. Below is an example with nine questions you can use straight away, with advice on filling it in, what to do after a no, and whether to choose paper or a digital form.

What makes a good LMRA form?

A form only works if people actually use it. Keep it to one A4 page or one screen, with eight to twelve questions in plain working language. Make the questions fit today's work: a form for work at height asks different things than one for machine maintenance.

The header holds name, date, time, location and the task you are about to do. At the bottom there is room for a note on deviations and for the name or signature of the person filling it in. You rarely need more, because every extra field costs time and makes ticking without looking more likely.

Example: nine questions for an LMRA form

Below is a basic form you can adapt. Every question is worded so that yes is the safe answer. That prevents mistakes on paper, because everyone reads it the same way: every no is a signal.

  • Do I know exactly what work I am about to do, and have I read the instruction, drawing or permit?
  • Is the work area cordoned off or marked out, and is there no other work or traffic nearby that could put us at risk?
  • Is the ground stable, dry and free of obstacles, and is fall risk at edges, openings, stairs and ladders covered?
  • Are machines, tools and equipment inspected and in good condition?
  • Am I wearing the required personal protective equipment, and is it undamaged?
  • Are electricity, pressure and moving parts shielded or isolated where needed?
  • Is there nothing present that I did not expect, such as dust, fumes, leaks or noise?
  • Does the situation match the instruction and the risk analysis, including the weather, staffing and time pressure?
  • Do I know where the escape route, extinguisher, first aid kit and assembly point are, and can I call for help?

How to fill in the form properly

Look first, tick afterwards. Walk around the work area with the form in your hand and answer each question based on what you see, not on what you expect or what applied yesterday. Filling it in in the van or the site cabin before you have seen the work area is the quickest way to detect nothing.

If you are unsure, the answer is no. A question you cannot answer is one you first need to look into. Fill in the form yourself, even if you work in a team, and then discuss what stood out so that everyone has the same picture.

What do you do after a no?

A no is not a mistake, it is exactly what the form is for. You do not start the work as long as the answer is no. What you do next depends on what you can fix safely.

  • Stop, keep away from the hazard and do not start the task.
  • Describe what is wrong, in your own words and preferably with a photo.
  • Fix it if that is safe and within your authority, for example by cordoning off, tidying up or fetching other tools.
  • If you cannot fix it yourself, call your supervisor or foreman and wait for a decision.
  • Go through the questions again after the fix and record what was agreed.
  • Report it as a deviation or near miss if the cause is wider, so that others do not run into it.

Adapting the form to the work

The basic form is a starting point. For work at height you add questions on scaffolding, guardrails and anchor points, and on whether anything could fall on people working below. For electrical work it is about isolating, shielding and checking that there is really no voltage left. In a production environment you ask about machine guarding, cleaning and colleagues nearby.

For transport and loading and unloading, add questions about the loading bay, traffic, load securing and visibility. Keep a short list per type of work rather than one long list for everyone. If the work has a permit or a task risk analysis, make the first question about whether you have read it and whether the situation matches.

Paper or digital: what suits your team?

A paper form is quick to make, works without signal or battery and fits in a pocket. The downside is that it easily gets lost, handwriting can be illegible and it is hard to see afterwards whether everyone did it. Getting an overview per team, week or project then takes a lot of manual work.

Digitally, you capture time, place and the person filling it in automatically, and you can mark a critical question that forces follow-up. You see at a glance who did the LMRA and which answers often deviate. Whether an LMRA has to be recorded is up to your client or safety system, but what is not recorded cannot be demonstrated later. A common route is to start on paper and switch once the volume or an audit calls for it.

Common mistakes when filling it in

Most mistakes do not come from bad intentions but from time pressure and a form that does not fit the work. Watch out for these points:

Every quarter, pull out a number of completed forms and check whether the questions still fit practice. Questions that always get a yes can be dropped or sharpened.

  • Ticking everything without looking around, often already in the van or before arrival.
  • One shared form for the whole team that nobody feels responsible for.
  • Questions where yes and no are mixed up, so people tick the wrong box.
  • Noting a no but starting anyway, without anyone looking at it.
  • Not updating the form after an incident, while the question that could have prevented it is missing.
  • No feedback, so employees do not notice that anything happens with their answers.

How BrydgeOne supports this

In the LMRA module you complete a form like this as a yes/no checklist, in the employee app or via a QR code or link. For each check question you decide whether yes or no is the safe answer and whether the question is critical; in the app the chosen answer turns green or red. By default, an LMRA with a point of attention becomes an incident report in Incidents & reports. With the TRA module, BrydgeOne checks whether the project has a valid task risk analysis, and at the daily start in Start-of-work meeting you look back at the agreements and reports since the previous daily start.

© 2026 BrydgeOne. General information, not legal or other professional advice. No rights can be derived from this article.

Frequently asked questions

Frequently asked questions

Does an LMRA form have to be signed?

That depends on your client and your safety system. A name or signature shows who filled in the form and makes that person co-responsible. Digitally, a logged-in or recognized user is often enough, but check what your client requires. Without any identification, the form is hard to use afterwards as evidence.

How often do you fill in an LMRA form?

For every new task, every change of location and whenever something changes during the work, such as the weather, staffing or method. For the same task in the same place, once a day is sometimes enough. Your client may require its own frequency.

How long do you keep a completed LMRA form?

There is no period that applies to everyone. Look at the requirements of your client, your certification scheme and your own policy, and choose a period that fits how long you need to be able to show what was done. Keep forms in one fixed place, with the project.

Can I use an LMRA form from the internet?

Yes, as a starting point, but adapt it. A generic form misses the risks of your work, which makes people start ticking boxes. Remove questions that are never relevant, add questions that keep appearing in your incidents and let colleagues who do the work test it first.

See how BrydgeOne supports this

You only pay for the modules you switch on, from € 49 per month. In a demo we show how it works with your own processes.