004 RMS Surveillance Checklist H4 WORKING IN CONFINED SPACES

• H4 WORKING IN CONFINED SPACES .

• Project Name: Tabulam New Bridge.

• Location: BRUXNER HIGHWAY TABULAM

• Contractor

• Prepared by

• Conducted on

  Date

• N.A Not Applicable. N.C Not Checked

Has a risk assessment and SWMS to include risks associated with access/egress, engulfment and contaminated air, developed in consultation with workers been completed for the following stages of the work:

• <br> Before commencement;<br><br>

  Yes

  No

  N.A.

  N.C.

•  During work activity,

  Yes

  No

  N.A.

  N.C.

•  In an emergency?

  Yes

  No

  N.A.

  N.C.

• Have all hazardous activities e.g. hot works, work with hazardous substances, operating plant, in or near the confined space, been identified, assessed and controlled?

  Yes

  No

  N.A.

  N.C.

• Has air monitoring been conducted and recorded (as required)?

  Yes

  No

  N.A.

  N.C.

• Has all monitoring equipment been tested and calibrated as required by manufacturers’ requirements?

  Yes

  No

  N.A.

  N.C.

• Have all persons required to enter the confined space completed nationally recognised training for confined space entry?

  Yes

  No

  N.A.

  N.C.

• Have confined spaces been signposted?

  Yes

  No

  N.A.

  N.C.

• Where possible, is a physical barrier erected around the confined space to prevent unauthorised entry of persons?

  Yes

  No

  N.A.

  N.C.

• Are arrangements/provisions for rescue, first aid and resuscitation in place prior to entry into the confined space?

  Yes

  No

  N.A.

  N.C.

• Is an entry permit completed, communicated and signed off by the stand by person and all those entering the site?

  Yes

  No

  N.A.

  N.C.

• Is there a procedure to ensure communication between the stand by person and those in the confined space at all times?

  Yes

  No

  N.A.

  N.C.

• Has the soundness and security of the overall structure and the need for illumination and visibility been assessed?

  Yes

  No

  N.A.

  N.C.

• Has the extent to which cleaning will be required in the confined space been assessed?

  Yes

  No

  N.A.

  N.C.

Have all persons entering the confined space received a site induction that covers at least:

• <br> Emergency exit/entrance procedures?<br>

  Yes

  No

  N.A.

  N.C.

•  First aid arrangements?

  Yes

  No

  N.A.

  N.C.

•  Lockout procedures?

  Yes

  No

  N.A.

  N.C.

•  Safety equipment use?

  Yes

  No

  N.A.

  N.C.

•  Rescue drills?

  Yes

  No

  N.A.

  N.C.

•  Fire protection?

  Yes

  No

  N.A.

  N.C.

•  Communications?

  Yes

  No

  N.A.

  N.C.

•  Site hazards?

  Yes

  No

  N.A.

  N.C.

• Is the activity compliant.

  Yes

  No

  N.A.

  N.C.

• Surveillance Officer

  Sign

• NCPN or memo number.

  Yes

  No

  N/A

• Follow up action

  Yes

  No

  N/A

• Product Non Conformance

  Yes

  No

  N/A

• System Non Conformance

  Yes

  No

  N/A

• Contractor generated NCR

  Yes

  No

  N/A

• Contractor generated a CAR

  Yes

  No

  N/A

Matters arising

• NCPN no

• Contractors NCR no

• CAR no

• Closed out.

• RMS representative's name

  Sign