• Project / task / work order description

  • Contracting company

  • Conducted on

  • Conducted by

  • Location
  • Completed with

Team responsible for or undertaking work

  • Group / team responsible for work

Assurance checks

  • JSEA/SWMS title, number and revision number (take photo)?

  • Can workers identify the following:<br>- what to do in an emergency, including assembly point? <br>- how to report an incident/hazard?<br>- requirements for contacting access officer on arrival and leaving site?<br>

  • Are all requirements of PASS procedure in place and current? (site access, MWP, PWP, CSP)?

  • Are all current permits in place? (hot work, confined space, height, grid mesh, excavation, penetration, isolation instructions)

  • Have all persons involved in the work signed onto the JSEA/SWMS or RTHA?

  • Have all relevant pre-starts been completed (meetings, plant etc)?

  • Have all hazards and controls been identified in the JSEA/SWMS or RTHA and the controls are being followed?

  • Do workers have the appropriate training/qualifications/competencies required to complete activities as specified in the JSEA/SWMS or RTHA?

  • Is all safety equipment (harnesses, tripods, slings, chains, gas detectors, portable RCD's, electrical leads etc) within test date?

  • Are all relevant SDS available and current and are appropriate controls in place?

  • Are all workers wearing specified PPE?

Sign off (completed report must be sent to PM or coordinator for reference)

  • Add signature

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