Information
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Asset number
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Site name
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Asset owner
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Conducted on
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Prepared by
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Location 1
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Location2
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Personnel
Vehicle Access
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Road access
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Name of road
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Nearest cross road
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Is the more than one access road to the asset
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Road surface
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Restrictions on vehicle access
- 4 wheel drive required
- weight restrictions on access road
- width restrictions on roadway
- no restrictions
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Enter details regarding all restrictions on the access road
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Weather restrictions on road
- 4 wheel drive
- causeway or floodway
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Land owners permission required
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Land owners contact details
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Access road maintained by
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Do you require swipe card access
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Do you require a key to access
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What keys are required
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Enter a detailed description of the main access route
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Enter a detailed description of the secondary access route
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Enter any other information re vehicle access
Worker access
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Can equipment and materials be easily transported to the work area
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Do workers require a level of fitness due to walking distance or number of stairs
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Access by stairs
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Ladder access
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Lift access
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Door access
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Man hole or hatch way
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Side hatch
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Work at height to access
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Is there a risk of slips / trips due to difficult terrain
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Does the access require attention
PPE
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Are site PPE requirement clearly displayed at entrance
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Hard hat
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Hi-Vis
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Safety boots
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Safety glasses
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Life jacket
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Long pants / shirts
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Safety harnesses
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Other PPE
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List other PPE
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Is there any mandatory site PPE signs missing
site induction
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Should there be a site specific induction for this site
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Is there a site specific induction
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Does the site specific induction require updating
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Who is responsible for delivering induction
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Is the site induction register avaliable
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Does it appear to have been updated
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Date last time induction was reviewed
Work Permits
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Are work permits required to work on the asset
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List permits required
Remote location
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Is the asset isolated from assistance due to location, time or nature of the asset
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Does the asset meet the lone and remote worker definition.
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Is there a ranger station near asset
Communications
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Mobile phone coverage
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TMR coverage
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Land line avaliable
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Other communications avaliable
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Communication cables overhead
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Communication cable underground
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Communication tower on or near asset
Electrical
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Electrical power at site
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Is there any exposed electrical hazards
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Power supplied overhead
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Who owns the poles
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Power suplied underground
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Backup generator on site
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Manual start generator
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Auto start generator
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Generator powers entire asset
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Generator powers part of asset
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Explain what the generator powers
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Does generator exhaust fumes affect working enviroment atmosphere
gas supply
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Does the site have gas connected
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Is gas supply above ground
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Is gas supply underground
water supply
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Is water supply above ground
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Is water supply underground
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Is potable water avaliable at site
water ways
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Is the asset on or near a waterway
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Is there restrictions around entering the waterway
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Is work carried out near a waterway
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Is work above a water way
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Is work carried out in the waterway
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Is work carried out by boat
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Is there a boat ramp
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Notes about this section
Security
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Does the site have a security fence
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Is the fence and gate in good condition
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Is there security camera's
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Is there any obstructions to the camera's field of view
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Is there a security alarm installed
Public access
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Do the public have unrestricted access to the asset
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Public Access times
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Public have vehicle access
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Public access by foot, bike, horse
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Notes about public access
Work at height
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To tasks at the site require work at height
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Is there a work at height register
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Are there WAH anchor points on site
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Is there a site register of anchor points
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Date of last inspection
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Is there a davit arm or mounting point at the asset
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Does the type or placement of WAH equipment require a new risk assesment
Confined space
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Is there a confined space at the asset
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Is there a confined space register
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Is there a confined space risk register
Asbestos
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Is the site listed on the asbestos register
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Does the site have its own register
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Is the presance of asbestos know or suspected
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Can the public easily access the area where they could disturb or be affected by disturbed or damaged asbestos
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How often do workers access the immediate vicinity of the asbestos
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is it likely workers will disturb the asbestos material during works
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Is the asbestos on site marked with the apropriate signage
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Has the asbestos had a visual check carried out in the last 12 months
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Last visual inspection
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Is there evidence of damage or deteriation of the visible asbestos
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Is there evidence of bitumas coatings on pipes at the site PAH.
Emergency plan
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Does the site require an emergency plan
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Is there a current emergency plan
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Is there EMP signage displayed
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Is there a safe muster point
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Has the EMP been reviewed in the last 12 months
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Last EMP review
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Has there been a full emergency drill in the last 12 months
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Last EMP drill
First aid
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Does the site require a permanent first aid station
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Are there first aid kits permanatly at the site
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Have they been checked and serviced
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Last service date
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Is there a first aider listed for the site
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Is there contact details clearly displayed
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Is there a first aid room
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Date of last inspection of the first aid room
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Are there eye wash stations at site
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Last inspection date
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Do any eye wash stations require maintenence
AORs applicable to the site
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Lock out Tag out
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Access and egress
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Confined space
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Traffic Management
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Plant and people interface
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Protection of underground services
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Mobile powered plant working near overhead power lines
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Temporary works design
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Excavation and trenching
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Mobile plant
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Work at height
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Exclusion zones
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Industrial rope access
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Electrical safety
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Hazardous chemicals
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Hot works
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Lone and remote
hazardous substances
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Are there hazardous or dangerouse substances regularly stored at the site
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Is there an upto date register
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Has an audit and risk assesment been carried out on the sites substances register
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Last audit date
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Is there a risk from aiborn contaminants
Bush fire
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Is the asset in a bushfire prone area
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Is there a fire break around the asset
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Does the fire protection provided require attention
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Are there fire fighting facilities at the asset
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Last inspection date
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Are potential ignition sources on or near the asset
wild life and cultural / heritage considerations
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Are there any known endangered wildlife at or near the asset
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Are there any threats to workers from wildlife at or near the asset
facilities
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Are there eating facilities at or near the asset
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Are there abolutions at or near the site
criticality and inspection
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Is this a critical asset
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What other assets will be afected if there is an issue here
Inspection and testing
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Does the asset require regular inspection and testing
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Details
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When was the last inspection/test carried out
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Who carries out thetesting / inspections
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Is there a record of the testing / inspection at the asset
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Is the inspection / testing records readily avaliable
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Where are the records kept