Title Page

  • Program Name

  • Reason for visit

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Pre-site checks

Pre-site checks

  • Have you checked the CRIP rating - if the property is tenanted

  • Have you checked the property/surrounds risk information

  • Have you completed a SWP if needed<br>

  • Have you arranged the visit as per established protocols and notified others

Self Assessment

Self assessment and Situational Awareness

  • Is my Secure Locate activated

  • Is it safe to exit my vehicle

  • Is the site secure and safe to enter

  • Am I wearing the correct PPE

Site Assessment - Part 1

Site Assessment Mandatory Section

  • Is fencing installed to prevent access to site

  • Is access control effective, no unauthorised access

  • Is "Sign in and out" system in place

  • Is the Hazard/Risk Register board in place

  • Has the Hazard/Risk Register board been updated today

  • Are the PPE requirements displayed

  • Is signage in place and appropriate for risk (e.g. report to site office, no entry, asbestos, danger)

  • Is induction or discussion of site risks held

  • Do the risks mentioned match the Hazard/Risk Register board

  • Are PPE requirements described

  • Is the induction/discussion recorded

Site Assessment - Part 2

Site Assessment Optional Section depending on activities on site/to be targeted

  • Emergency Equipment Section

  • Is a fire extinguisher available

  • Is the first aid kit complete and available

  • Is a spillage kit on site

  • Are risk specific Emergency Response Plans available and easy to access

  • Are emergency numbers available and easy to access

  • Documentation Section

  • Are clearance certificates on site e.g. asbestos, methamphetamine

  • Is a SSSP available on site

  • Are safety meeting minutes added to SSSP

  • Is the SSSP in daily use

  • Is SSSP content known on site

  • Are SDS available and easy to access

  • If asbestos being removed, is an Asbestos Removal Control Plan at site and being followed

  • If a Traffic Management Plan is in place, is it being followed

  • Site housekeeping and facilities Section

  • General site tidy and orderly, free of trip hazards

  • Are materials stacked safely

  • Are materials damaged beyond use (chemical decon only)

  • Are stacking areas demarcated

  • Are hazards demarcated (e.g. trenches)

  • Are waste materials stored in bins

  • Are waste materials sorted for recycling

  • Are bins used for hazardous materials lined

  • Are bins marked correctly

  • Are toilet facilities and running water accessible on site

  • Are exposed reinforcing bars capped

  • Personnel on site Section

  • ID tags carried and current

  • Supervisor or designated backup available on site during visit

  • PPE and manual handling Section

  • Are requirements known on site

  • Are all workers wearing correct PPE

  • Are there clean/contaminated areas for PPE on/off and cleaning

  • Are acceptable manual handling methods being used for tasks observed

  • Working at Height Section

  • Has the most appropriate equipment been chosen for work at height e.g. scaffolding, mobile scaffolding, elevated platform, ladder

  • If work is being conducted within 4m of overhead power lines is effective isolation in place (e.g. power disconnection, sleeving, or close approach consent).

  • Scaffolding Section

  • Is the tag valid (present, weekly inspection recorded, completed in full)

  • If the scaffolding exceeds 5m in height has WorkSafe been notified (does not apply if single storey home)<br>

  • If the scaffolding exceeds 5m in height has it been erected by a holder of a current certificate of competence

  • Is scaffolding installed to standard (e.g. soleboards 500mm x 200mm x 38mm thick, base boards, platforms, toe boards, stabilising legs, stand offs, gates, ladder attachments, edge protection installed effectively)

  • Ladders Section

  • Is the ladder set up at 1:4 ratio (1m horizontal to 4m vertical)

  • Can users maintain 3 points of contact at all times

  • Is the ladder secured at top and base to prevent slipping sideways/out

  • Do all ladders have more than 3 steps

  • Power Supply Section

  • Are safety devices in place

  • If power isolated is a lock out device in place with tag

  • Have power source (e.g. distribution box) leads been tagged

  • Are tags valid and leads in good working order

  • Are leads used in a safe manner

  • Tools & Machinery Section

  • Are power tool tags valid

  • Are safety devices operable i.e. not tampered with

  • Are the right tools or machinery being used for the job

  • Are all dangerous parts guarded

  • Do all tools and machinery appear to be in good working order

  • Hazardous Substances Section

  • Is dust control in place at source for respirable dust and/or paint particles e.g. timber, silica, lead based paint

  • Is waste from any dust extraction system disposed of safely

  • Is correct PPE for cutting activities worn (e.g. ear protection, eye protection, P2 dust mask)

  • Are lead test results on site

  • Are lead containment controls sufficient and in good condition (e.g. plastic sheeting ground cover, sealed openings) <br>

  • Is HNZ permitted method used for lead based paint removal (chemical stripping, wet scraping, wet hand sanding) <br>

  • Pre-line quality inspection section

  • Is building paper installed in accordance with approved plan

  • Has correct insulation product type been used

  • Is insulation installed in accordance with approved plan

  • Is the envelope bracing adequate (e.g. diagonal timber bracing / L brackets on top or bottom plates)

  • Is the envelope framing in good condition (e.g. no borer or timber rot visible)

  • Post decontamination & Prestart quality inspection section

  • Is the property secured (e.g. windows and doors closed/boarded)

  • Are all skip bins and refuse removed

  • Is electrical isolation completed appropriately (e.g. as per Completed Works Form)<br>

  • Have wires been cut to length that is reusable (i.e. not too short)<br>

  • Is the condition of timber where paint has been removed acceptable

  • Have all tenant belongings and soft furnishings been removed

  • Have the grounds been maintenance (e.g. length of lawn)

  • Is a copy of an asbestos survey present at site (prestart only)<br>

  • Are any items identified that have not been included in the architects plan i.e. potential variations (prestart only)

  • Is there room at site for bin storage and contractor parking (prestart only)

  • Post-line quality inspection section

  • Is Gib on bracing walls fixed in accordance with bracing plans (include photos of each labelled bracing wall)

  • Practical completion quality inspection section

  • Are exterior site works completed in accordance with Scope of Works

  • Are exterior building envelope and structure completed in accordance with Scope of Works

  • Are interior works completed in accordance with Scope of Works<br>

  • Are interior joinery completed in accordance with Scope of Works<br>

  • Have wires been cut to length that is reusable (i.e. not too short)<br>

  • Are building services completed in accordance with Scope of Works

  • Are services completed in accordance with Electrical Plan

  • Are floor finishes completed in accordance with floor finishing plan

Summary

Positive Observations

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Opportunities for improvement

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Actions completed at site

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Agree future/corrective actions

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General comments

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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.