Information

  • Document No.

  • Job Title

  • Client:

  • Enter Client Name Here

  • Time of Job Start Form being completed

  • Prepared by

  • Enter Name Here

  • Location of Job

Daily Job Record

  • Description of Job

  • Other

  • TMP Number

  • Job Number

  • STMS

  • Add Employees

  • Labour Hire

  • Other

  • Start Time

  • Finish Times

  • Total Hours

  • Did you have a 30 min break?

  • Truck Number

  • Driver
  • Times same as STMS

  • Start Time

  • Finish Time

  • Total Hours

  • 30 Minute Break

  • Truck Number

  • TC
  • Times same as STMS?

  • Start Time

  • Finish Time

  • Total Hours

  • 30 Minute Break

  • Job Comments

  • Additional Comments
  • Signed:

  • Add media

Daily Closure

  • Type of Closure:

  • Shift Time

  • TSL Already Installed?

  • TSL Installed:

  • TSL Removed:

  • Weather Conditions:

  • Work Operations:

Closure Equipment Checks (Check PPE, Safety Jackets, Cones, Signs...)

    Check Number
  • Comments/Conditions: (Note any missing signs, signs or cones down, etc...)

  • Add media

  • Signed:

Accidents/Incidents:

  • Accidents/Incidents:

  • Accident/Incident
  • Date/Time of Incident

  • Accident/Incident Description:

  • Signed

  • Event Report Filed Out?

Job Start

  • 1. LOOK - Do the Job START

  • 2. TELL - My mate if he is being UNSAFE

  • 3. TALK - About the Hazard Controls and Behaviours

  • Onsite Client Representative

Risk Rating Chart

  • 1. What can harm me?
    2. What can harm others?
    3. What can harm the environment?

  • Common Hazards

  • Lots of contractor movements

  • Good toolbox (site entry procedures), designated site access, other work vehicles well away.

  • Poor Road Surface

  • Side friction, speed restriction, additional advanced warning (new seal?)

  • Mobility Scooters

  • Good road surface, additional pedestrian lane width, use of driveways

  • Large Vehicles

  • Additional lane width, turning circles, tapers at good length

  • Weather

  • Additional signage, condition of signage, additional cones, extra sandbags, cable tie signage to poles, additional safety zones

  • Cyclists (cycle lane diversion/allowence)

  • Additional lane width, visibility,shoulders available

  • Excess Speed

  • Narrow lanes, speed restriction, side friction kerb line of cones, additional safety zones

  • Pedestrians (footpath closed)

  • Placed where good visibility is achievable, out of worksite, TC on site, inside speed restriction

  • Pedestrians (footpath detour)

  • 1.2m wide, cone barrier arms/safety fencing to contain, no trip hazards on route

  • Traffic/Vehicles

  • Positive Traffic Management, good delineation, side friction, RGs

  • Visibility

  • Good signage visibility, centreline of cones, side friction, extra safety zone area

  • Site Specific Hazard
  • Hazard Description

  • Likelihood of Harm

  • Potential Consequences

  • Risk Rating Before Controls

Hazard Controls (How can we reduce personal and environmental harm here?)

  • Behaviour/Action to eliminate, isolate or minimise:

  • Person or Team Responsible

  • Labour Hire

  • Other

  • Completed By: (initials)

  • Date

  • Signed by All Workers or Visitors to site:
  • Signed

TMP Modification

    TMP Mod
  • Add media

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.