3WL General Site Visit Form

• Conducted on

  Date

• Client / Site

• Location
  Address

• Prepared by

• Other personnel

• Document No.

• Reason for site visit

  Field Investigation

  Site monitoring

  Condition Assessment

  Other . . . .

• Weather

  Fine

  Overcast

  Showers

  Rain

• List Personal Protective Equipment required for inspection activities

  Select Steel toes Hi viz gear Hard hat Wet weather gear Gloves Harness Sunscreen Sunglasses Ear muffs Dust-mask No PPE Required (add comment)

  • Steel toes
  • Hi viz gear
  • Hard hat
  • Wet weather gear
  • Gloves
  • Harness
  • Sunscreen
  • Sunglasses
  • Ear muffs
  • Dust-mask
  • No PPE Required (add comment)

• Is any of the following being undertaken:<br> - Heavy lifting (> 20 kgs)<br> - Obstructing traffic<br> - Confined/restricted space entry<br> - Climbing (either up or down) ladder or similar<br> - Traversing uneven terrain<br> - Working with tools

  Yes

  No

• Has the appropriate site assessment and mitigations been carried out?

  Yes

  No

• Have all staffed involved with the inspection been involved with the completion of this form, and been briefed regarding the hazards and required responses and PPE?

  Yes

  No

• Does this inspection include monitoring, supervision and quality assurance for a construction project?

  Yes

  No

Trenching

• Trench width, depth, shoring okay

  Yes

  No

  N/A

Bedding/backfill

• Backfill/bedding okay

  Yes

  No

  N/A

Pipework

• Pipework okay?

  Yes

  No

  N/A

Node connections

• Node connections okay? (Manholes, junctions, etc)

  Yes

  No

  N/A

Compaction

• Compaction okay? Tested?

  Yes

  No

  N/A

Reinstatement (Both temp and final)

• Reinstatement okay?

  Yes

  No

  N/A

Quality Plan

• Compliance with Quality plan?

  Yes

  No

  N/A

Environmental plan

• Compliance with environmental plan?

  Yes

  No

  N/A

General comments on progress

• Enter any general comments and images on quality and progress of project

• General Progress Photos

  Media

• Is a health and safety audit part of the inspection

  Yes

  No

General

• Plant and Equipment

  Select Excavators Loaders Breakers Trucks Rollers

  • Excavators
  • Loaders
  • Breakers
  • Trucks
  • Rollers

• # of workers?

• Materials on site

• # of incidents since last visit

Site safety

• Safe work practices generally

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Compliance with site specific Health and Safety Plan

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Site incident register

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Trench Safety including shoring

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• PPE

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Equipment Safety

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Confined spaces

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Buried services

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Signage

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Barricading

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Signage

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Traffic Management<br>- TMP Implementation<br>

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Traffic Management<br>- Signage/ Cones/ Barricades<br>

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Traffic Management<br>- On-Site Records<br>

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Materials (storage, safe usage, appropriate precautions)

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Notifiable works (notifications completed)

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Emergency Procedures Clearly Displayed On Site

  Not Applicable

  Applicable but not addressed

  Inadequately addressed

  Meets contract standard

  Exceeds contract standard

• Other? (amenities, site-keeping etc.)

  Yes

  No

  N/A

Summary and signoff

• Are remedial actions required?

  Yes

  No

• Have the remedial actions been discussed with, and understood by, the person who will ensure they are carried out?

• Signature of inspector carrying out audit

  Sign

• Signature of contractor to confirm they have been briefed of results and remedial actions

  Sign