3CIX Site QHSE Audit

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Customer

• Activity

Site Safety Management

• Is team in complete PPE (required for the task)?

  Yes

  No

  N/A

• Safety Boots

  Pass

  Fail

  N/A

• Safety/climbing Helmet?

  Pass

  Fail

  N/A

• High viz jacket

  Pass

  Fail

  N/A

• Gloves

  Pass

  Fail

  N/A

• Dust mask

  Pass

  Fail

  N/A

• Ear defenders/ Hearing Protection

  Pass

  Fail

  N/A

• Site PPE compliance Observation/Comments

• Chapter 8/safety /warning signs with sufficient information are in place??

  Yes

  No

  N/A

• Is there any suitable storage of PPEs provided in van?

  Pass

  Fail

  N/A

• Is work site tidy and free from tripping hazards?

  Yes

  No

  N/A

• Do operatives have relevant safety training certifications?

  Yes

  No

  N/A

• Are all barriers set up properly and correctly as per code of practice?

  Pass

  Fail

  N/A

• Are originals or valid copies of the operatives certification available on site?<br>

  Yes

  No

  N/A

• Is there a certified person in team for First Aid/CPR?

  Yes

  No

  N/A

• Risk assessment carried out before activity?

  Yes

  No

  N/A

• Is the worksite clean of trash and debris?

  Yes

  No

  N/A

• Are alternative passenger/public footways arrangements are in place?

  Yes

  No

  N/A

• Is valid work permit available with team? If applicable

  Yes

  No

  N/A

• Working GDU available with team?

  Yes

  No

  N/A

Work At Height Safety Arrangements

• Fall protection PPEs (Full body harness) is in good condition? Any visible wear and tear?

  Yes

  No

  N/A

• Full body harness/lanyards/working belt? Worn during work at height?

  Yes

  No

  N/A

• Do operatives have relevant safety training certifications? S001/S001A/S8.

  Yes

  No

  N/A

• Is work being carried out using MEWP?

  Yes

  No

  N/A

• ing MEWPS? Is the MEWP/ Cherry Picker LOLER certified?

  Yes

  No

  N/A

• Is operator Qualified IPAF?

  Yes

  No

  N/A

Environmental Safety Management

• Are there sufficient arrangements for waste management at site?

  Yes

  No

  N/A

• All fiber waste, optical (glass) ends shards safely contained in correct sharps container

  Yes

  No

  N/A

• Are left over material at site is properly disposed off? (Empty boxes, metal scraps, plastic)

  Yes

  No

  N/A

• Is plant, vehicle or equipment is shut down when not in use? (To cut down CO2 emissions)

  Yes

  No

  N/A

Vehicle safety Management

• Is site vehicle equipped with complete and valid first aid box?

  Pass

  Fail

  N/A

• Does vehicle have correct fire extinguisher (ABC) with accurate pressure?

  Pass

  Fail

  N/A

• Are Vehicle tires in good condition? (Any wear and tear/ damage to tire)

  Good

  Fair

  Poor

  N/A

• Does vehicle have working beacons and approriate chevron markings?

  Pass

  Fail

  N/A

• Are all lights and wipers working?

  Pass

  Fail

  N/A

• Any damage to vehicle/abnormal sound/smell or leakage?

  Pass

  Fail

  N/A

Closing Comments

• Team Lead Name

• Observation/closing remarks:

• Auditor signature

  Sign