Information

  • Asset number

  • Site name

  • Asset owner

  • Conducted on

  • Prepared by

  • Location 1
  • Location2
  • Personnel

Vehicle Access

  • Road access

  • Name of road

  • Nearest cross road

  • Is the more than one access road to the asset

  • Road surface

  • If access is via unsealed road how many Klm

  • Restrictions on vehicle access

  • Enter details regarding all restrictions on the access road

  • Weight restrictions for road if any

  • Weather restrictions on road

  • Land owners permission required

  • Land owners contact details

  • Access road maintained by

  • Do you require swipe card access

  • Do you require a key to access

  • What keys are required

  • Enter a detailed description of the main access route

  • Enter a detailed description of the secondary access route

  • Enter any other information re vehicle access

Worker access

  • Can equipment and materials be easily transported to the work area

  • Do workers require a level of fitness due to walking distance or number of stairs

  • Access by stairs

  • Ladder access

  • Lift access

  • Door access

  • Man hole or hatch way

  • Side hatch

  • Work at height to access

  • Is there a risk of slips / trips due to difficult terrain

  • Does the access require attention

PPE

  • Are site PPE requirement clearly displayed at entrance

  • Hard hat

  • Hi-Vis

  • Safety boots

  • Safety glasses

  • Life jacket

  • Long pants / shirts

  • Safety harnesses

  • Other PPE

  • List other PPE

  • Is there any mandatory site PPE signs missing

site induction

  • Should there be a site specific induction for this site

  • Is there a site specific induction

  • Does the site specific induction require updating

  • Who is responsible for delivering induction

  • Is the site induction register avaliable

  • Does it appear to have been updated

  • Date last time induction was reviewed

Work Permits

  • Are work permits required to work on the asset

  • List permits required

Remote location

  • Is the asset isolated from assistance due to location, time or nature of the asset

  • Does the asset meet the lone and remote worker definition.

  • Is there a ranger station near asset

Communications

  • Mobile phone coverage

  • TMR coverage

  • Land line avaliable

  • Other communications avaliable

  • Communication cables overhead

  • Communication cable underground

  • Communication tower on or near asset

Electrical

  • Electrical power at site

  • Is there any exposed electrical hazards

  • Power supplied overhead

  • Number of poles to boundary

  • Who owns the poles

  • Power suplied underground

  • Backup generator on site

  • Generator size (kva)

  • Manual start generator

  • Auto start generator

  • Generator powers entire asset

  • Generator powers part of asset

  • Explain what the generator powers

  • Does generator exhaust fumes affect working enviroment atmosphere

gas supply

  • Does the site have gas connected

  • Is gas supply above ground

  • Is gas supply underground

water supply

  • Is water supply above ground

  • Is water supply underground

  • Is potable water avaliable at site

water ways

  • Is the asset on or near a waterway

  • Is there restrictions around entering the waterway

  • Is work carried out near a waterway

  • Is work above a water way

  • Is work carried out in the waterway

  • Is work carried out by boat

  • Is there a boat ramp

  • Notes about this section

Security

  • Does the site have a security fence

  • Is the fence and gate in good condition

  • Is there security camera's

  • Number of cameras

  • Is there any obstructions to the camera's field of view

  • Is there a security alarm installed

Public access

  • Do the public have unrestricted access to the asset

  • Public Access times

  • Public have vehicle access

  • Public access by foot, bike, horse

  • Notes about public access

Work at height

  • To tasks at the site require work at height

  • Is there a work at height register

  • Are there WAH anchor points on site

  • Dyna bolt anchors

  • Chem set anchors

  • Anchor plates

  • Push lock anchor sockets

  • Eye bolts

  • Total number of anchor points

  • Is there a site register of anchor points

  • Date of last inspection

  • Is there a davit arm or mounting point at the asset

  • Core mount davit point

  • Fixed davit point

  • Does the type or placement of WAH equipment require a new risk assesment

Confined space

  • Is there a confined space at the asset

  • Is there a confined space register

  • Is there a confined space risk register

Asbestos

  • Is the site listed on the asbestos register

  • Does the site have its own register

  • Is the presance of asbestos know or suspected

  • Can the public easily access the area where they could disturb or be affected by disturbed or damaged asbestos

  • How often do workers access the immediate vicinity of the asbestos

  • is it likely workers will disturb the asbestos material during works

  • Is the asbestos on site marked with the apropriate signage

  • Has the asbestos had a visual check carried out in the last 12 months

  • Last visual inspection

  • Is there evidence of damage or deteriation of the visible asbestos

  • Is there evidence of bitumas coatings on pipes at the site PAH.

Emergency plan

  • Does the site require an emergency plan

  • Is there a current emergency plan

  • Is there EMP signage displayed

  • Is there a safe muster point

  • Has the EMP been reviewed in the last 12 months

  • Last EMP review

  • Has there been a full emergency drill in the last 12 months

  • Last EMP drill

First aid

  • Does the site require a permanent first aid station

  • Are there first aid kits permanatly at the site

  • Have they been checked and serviced

  • Last service date

  • Is there a first aider listed for the site

  • Is there contact details clearly displayed

  • Is there a first aid room

  • Date of last inspection of the first aid room

  • Are there eye wash stations at site

  • Number of eye wash stations

  • Last inspection date

  • Do any eye wash stations require maintenence

AORs applicable to the site

  • Lock out Tag out

  • Access and egress

  • Confined space

  • Traffic Management

  • Plant and people interface

  • Protection of underground services

  • Mobile powered plant working near overhead power lines

  • Temporary works design

  • Excavation and trenching

  • Mobile plant

  • Work at height

  • Exclusion zones

  • Industrial rope access

  • Electrical safety

  • Hazardous chemicals

  • Hot works

  • Lone and remote

hazardous substances

  • Are there hazardous or dangerouse substances regularly stored at the site

  • Is there an upto date register

  • Has an audit and risk assesment been carried out on the sites substances register

  • Last audit date

  • Is there a risk from aiborn contaminants

Bush fire

  • Is the asset in a bushfire prone area

  • Is there a fire break around the asset

  • Does the fire protection provided require attention

  • Are there fire fighting facilities at the asset

  • Last inspection date

  • Are potential ignition sources on or near the asset

wild life and cultural / heritage considerations

  • Are there any known endangered wildlife at or near the asset

  • Are there any threats to workers from wildlife at or near the asset

facilities

  • Are there eating facilities at or near the asset

  • Are there abolutions at or near the site

criticality and inspection

  • Is this a critical asset

  • What is the minimum responce time if the asset stops working in hours

  • What is the maximum responce time allowed

  • What other assets will be afected if there is an issue here

Inspection and testing

  • Does the asset require regular inspection and testing

  • Details

  • When was the last inspection/test carried out

  • Who carries out thetesting / inspections

  • Is there a record of the testing / inspection at the asset

  • Is the inspection / testing records readily avaliable

  • Where are the records kept

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.