• Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1. Administrative Procedures

  • 1.1 Is the Site Specific Safety Plan document on site ?

  • 1.2 Is Site Specific Safety Plan is revised on a regular basis

2. Compliance with the Site Specific Safety Plan

  • 2.1 Does the contractor have an adequate induction process for workers, contractors and visitors?

  • 2.2. Does the contractor have a register of training, licenses and skills

  • 2.3. Does the contractor have an adequate Safe Work Method Statements (SWMS) for high- risk work?

  • 2.4. Lack of, or inadequate system to review SWMS as needed?

  • 2.5. Review the contractors incident notification procedures?

  • 2.6. Lack of, or inadequate, routine inspections, monitoring, audits?

  • 2.7. Lack of/or inadequate consultative arrangements?

  • 2.8. Does the contractor have an adequate supervisory arrangements?

3. Plant and Equipment

  • 3.1. Unsafe or damaged plant/equipment? (including missing or damaged guards)

  • 3.2. Incorrect plant /equipment for job?

  • 3.3. Unsafe or incompatible attachments used with plant/equipment?

  • 3.4. licensing or proof competency of operators?

  • 3.5. Recorded procedures for cleaning, servicing and maintenance?

4. Lifting Equipment

  • 4.1 Are any loads lifted over persons, close proximity to obstacles incl. overhead power lines?

  • 4.2. Is the equipment maintained, is it tested and inspected on a regular basis

  • 4.3. Is SWL information displayed?

  • 4.4. Unsafe or damaged lifting equipment, including ropes, slings, chains, hooks?

  • 4.5. licensing or proof competency of operators?

  • 4.6. Recorded procedures for cleaning, servicing and maintenance?

5. Hazardous Manual Tasks

  • 5.1. Lack of identification hazardous manual tasks?

  • 5.2. Lack of assessment of hazardous manual tasks?

  • 5.3. Inadequate risk controls? (examples: no job rotation, lighter loads, trolleys, lifting equipment, etc)

  • 5.4. Lack of training in risk controls and safe lifting/ team lifting techniques?

6. Hazardous Chemical (including fuel and oil)

  • 6.1. Unsafe storage location? (e.g. flammables near ignition sources, spills could enter stormwater drains, etc)

  • 6.2. Incompatible chemicals stored near each other?

  • 6.3. Inadequate spill containment equipment?

  • 6.4. Safety Data Sheets not accessible on site?

  • 6.5. Lack of emergency procedures for injury/spills/fire etc?

  • 6.6. Excessive quantities stored on site or in vehicles?

  • 6.7. Insufficient ventilation?

  • 6.8. Insufficient, or incorrect, PPE?

  • 6.9. Unsuitable storage containers? (unlabeled or stored in food containers)

7. Emergency Response

  • 7.1. Lack of, or no emergency plans for site?

  • 9.2. Emergency procedures not displayed at site?

  • 9.3. Lack of training and rehearsal of emergency plans?

  • 9.4. Lack of, or inadequate first aid kits aid equipment for site?

  • 9.5. Insufficient access to formally trained First Aiders for all shifts?

  • 9.6. Unsuitable or inadequate communication equipment?

10. Traffic Management

  • 10.1. Lack of, or inadequate, Traffic Management Plan (TMP) in place?

  • 10.2. Lack of training in TMP for all persons on site? <br>(contractors and visitors)

  • 10.3. Inadequate controls for TMP? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)

11. Personal Protective Equipment (PPE)

  • 11.1. Lack of, or inadequate PPE (including sun protection)

  • 11.2. Lack of system to issue, inspect, replace and monitor PPE?

  • 11.3. Lack of training in safe use, clean-up and inspection of PPE?

12. Work Environment

  • 12.1. Lack of/or inadequate amenities? (toilets, wash areas, lunch rooms, etc)

  • 12.2. Insufficient lighting?

  • 12.3. Inadequate housekeeping?

  • 12.4. Lack of, or inadequate noise/ vibration control?

13. Electrical Hazards

  • 13.1. Unsafe electrical leads? (damaged, out of test date or untested)

  • 13.2. Lack of RCD protection?

  • 13.3. Contact with underground assets? DBYD Documents on site

  • 13.4. Contact with overhead electrical lines?

  • 13.5. Overloading outlets?

  • 13.6. Leads placed on ground or on metal structures?

  • 13.7. Electrical equipment near water?

  • 13.8. Electrical equipment near flammables?

  • 13.9. Electrical equipment near chemicals that could cause damage?

  • 13.10. Electrical leads that may be damaged from contact with moving machinery parts?

  • 13.11. Electrical leads on work surfaces?

Corrective Actions

  • Enter any corrective actions that will be undertaken

Sign Off

  • Gippsland Water Responsible Officer

  • On site representative

  • Auditor's signature

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.