Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Pre-Start Meeting Conducted by:
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Enter Signature of Person Conducting Meeting:
Scope of Works for Shift:
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Enter Scope of Works for Shift:
Date & Time:
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Enter Date & Time:
Address of Nearest Hospital:
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Enter Address of Nearest Hospital:
Name of First Aid Officer:
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Enter Name of First Aid Officer:
Contact Phone:
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Enter Contact Phone:
Section 1 - High Risk Tasks
Perform a Site Check prior to commencing all works, to ensure all hazards are identified. Tick the following checklists for hazard areas identified. Please specify Other if applicable.
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Traffic / Pedestrians
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Mobile Plant
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Utilities (overhead & underground)
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Sensitive Flora/Fauna
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Weeds
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Fixed Structures
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Manual Handling
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Heights
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Site Debris
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Site Access
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Chemicals
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Fire & Emergency
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Animals
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Waste Materials
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Weather
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Ground Conditions
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Waterway
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Terrain
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Other
Is Protective Clothing required? Please tick all that are required for the task. Please specify other if applicable.
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Foot wear
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Fall Arrest
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High Vis
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Gloves
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Hard Hat
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Hearing Protection
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Eye Wear
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Respirator
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Other
Section 2 - Requirements
Site / Project (inc Location)
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Enter Site / Project (inc Location)
Evacuation Point
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Enter Evacuation Point
Are controls in place to ensure personnel working in the vicinity of the mobile plant and public vehicles are safe: ie Restricted access, barriers, exclusion zones, traffic control, (Rail) track protection etc? Remember the minimum exclusion zones around Mobile Plants.
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Yes
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No
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Upload a photo if you have evidence
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Enter any other comments you may have?
Will reversing of plant & vehicles be taking place on site? (If yes, designated spotter required at all times)
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Yes
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No
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Enter any other comments you may have?
Have all services been identified? (Overhead power lines etc)
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Yes
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No
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Enter any other comments you may have?
For all high risk tasks identified above, is a SWMS being used and signed off?
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Yes
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No
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Upload a photo if you have evidence
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Enter any other comments you may have?
Are all equipment fit for purpose and in good working condition? (If not, all equipment in poor condition is to be removed, isolated and/or tagged out)
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Yes
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No
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Upload a photo if you have evidence
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Enter any other comments you may have?
Are all plant operators or trades onsite licensed, competent and fit for work? Documents must be verified.
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Yes
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No
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Upload a photo of their licence and any other documentation
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Enter any other comments you may have?
Are all personnel, including contractors wearing the appropriate PPE for the job? (As identified on previous chart)
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Yes
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No
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Upload a photo if you have evidence
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Enter any other comments you may have?
Are emergency procedures in place including accessible equipment (Fire Extinguisher, First Aid Kit etc)?
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Yes
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No
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Enter any other comments you may have?
Are any adverse weather conditions predicted for the shift? ie High Temperature / humidity / storms / flood warning/ Total Fire Bans / Fire Danger Periods. Etc?
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Yes
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No
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Enter any other comments you may have?
Do all Contractors have authority to work permits, signed and dated?
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Yes
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No
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Take a photo of authority to work permits, signed and dated
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Enter any other comments you may have?
Section 3 - Risk Assessment Table
No 1: Hazard / Non-conformances
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Enter Hazard or Non-Conformance
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Initial Risk Score
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Enter Control Actions
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2nd Risk Score
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Responsible Person
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Responsible Person Signature
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Enter Date Completed
No 2: Hazard / Non-conformances
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Enter Hazard or Non-Conformance
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Initial Risk Score
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Enter Control Actions
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2nd Risk Score
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Responsible Person
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Responsible Person Signature
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Enter Date Completed
No 3: Hazard / Non-conformances
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Enter Hazard or Non-Conformance
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Initial Risk Score
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Enter Control Actions
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2nd Risk Score
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Responsible Person
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Responsible Person Signature
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Enter Date Completed
Section 4 - Other Items
List all other items to be discussed at Pre-Meeting
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Enter Other Items Discussed
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Enter Other Items Discussed
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Enter Other Items Discussed
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Enter Other Items Discussed
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Enter Other Items Discussed
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Enter Other Items Discussed
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Enter Other Items Discussed
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Enter Other Items Discussed
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Enter Other Items Discussed
Which SWMS was used on site?
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Enter SWMS Number and Name
Section 5 - Sign Off
List all attendees and signature
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Attendee Name:
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Attendee Signature:
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Attendee Name:
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Attendee Signature:
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Attendee Name:
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Attendee Signature:
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Attendee Name:
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Attendee Signature:
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Attendee Name:
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Attendee Signature:
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Attendee Name:
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Attendee Signature:
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Attendee Name:
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Attendee Signature:
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Attendee Name:
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Attendee Signature:
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Attendee Name:
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Attendee Signature:
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Attendee Name:
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Attendee Signature:
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Attendee Name:
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Attendee Signature:
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Attendee Name:
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Attendee Signature:
