016 General Worksite Safety Inspection Form

• Project Description:

• Client:

• Job No.

• Location
  Address

• Conducted on

  Date

• Inspected By:

• Also Present:

General Checks

• This list of questions is not exhaustive and any other good or bad practice of note should be recorded in the observations section.

• 01 - Have personnel completed a Take 5 Risk Assessment for works being undertaken?

  Yes

  No

  Shortfalls

  N/A

• 02 - Do personnel have the appropriate authorisation / PTW for the work being undertaken, e.g. Hot Work Permit?

  Yes

  No

  Shortfalls

  N/A

• 03 - Are access and egress arrangements safe, including working at height access (Ladders, scaffolding tagged, etc.)?

  Yes

  No

  Shortfalls

  N/A

• 04 - Is housekeeping / tidyness acceptable in the work area, and is it free from slip, trip and fall hazards?

  Yes

  No

  Shortfalls

  N/A

• 05 - Are all personnel wearing the correct PPE for work being undertaken? (As a minimum, Safety footwear, protective overalls, eye protection, Safety Helmet).

  Yes

  No

  Shortfalls

  N/A

• 06 - Are all hazards suitably controlled and appropriate measures taken to ensure the health and safety of Burgess Marine personnel and others who may be affected by their activities?

  Yes

  No

  Shortfalls

  N/A

• 07 - Do personnel have the relevant instruction and training to carry out the work safely?

  Yes

  No

  Shortfalls

  N/A

• 08 - Is all plant, equipment and tools (powered or manual), in good visible condition and displaying the appropriate maintenance tag/label?

  Yes

  No

  Shortfalls

  N/A

• 09 - Does the work group have a First Aider amongst them, or if not, access to a customer trained First Aider?

  Yes

  No

  Shortfalls

  N/A

• 10 - If working at height (i.e. next to an exposed edge), are the following control measures in place: action taken to prevent falls (e.g. hand rails, fall restraint harnesses or catch nets)?

  Yes

  No

  Shortfalls

  N/A

• 11 - If carrying out hot work (e.g. burning, welding or grinding), are the following control measures in place: Hot work permit, Fire Watch, firefighting equipment?

  Yes

  No

  Shortfalls

  N/A

• 12 - If carrying out confined space work, are the following control measures in place: Personnel trained in confined space working, entry permit in place, communications in place, escape sets and gas monitors present and in use, Topman present, rescue arrangements in place?

  Yes

  No

  Shortfalls

  N/A

• 13 - Please confirm that the work being undertaken does not pose any risk to the environment, and if not are suitable control measures in place (e.g. Spill kits, booms, dust containment, etc.)?

  Yes

  No

  Shortfalls

  N/A

• 14 - Is all waste / rubbish being captured and controlled for removal from site?

  Yes

  No

  Shortfalls

  N/A

Observations and Recommendations

• Please make a note of any general observations including Good or Bad practice.

• Observations

• Photos

  Media

• Recommendations

• Actionee: