ADG Site Visit

• Site conducted

  Select
• Location/Site
  Address

• Contractor

• Conducted on

  Date

• Prepared by

Pre-Site Visit Checks

• Confirmed if tenant risk rating exists. If yes, identify response.

  Yes

  No

  N/A

• Confirmed if property risk info exists. If yes, identify response

  Yes

  No

  N/A

• Arranged visit as per established protocols.

  Yes

  No

  N/A

Pre-Entry Site Checks

• Up-to-date hazard board displayed at site entrance

  Yes

  No

  N/A

• Carrying Site Safe Passport and wearing correct PPE for this site

  Yes

  No

  N/A

• Site access control and induction protocol observed

  Yes

  No

  N/A

• Site Hazards (Select the applicable hazard or note any others)

  Select None Radiation Biohazard Hazardous Substance Electrical Trip Fall Stairs Overhead Hand Pinch Body Pinch Machinery Mobile Plant Gas Bottles Hot Work Fire Explosion Eye Hearing Unstable Object Animals

  • None
  • Radiation
  • Biohazard
  • Hazardous Substance
  • Electrical
  • Trip
  • Fall
  • Stairs
  • Overhead
  • Hand Pinch
  • Body Pinch
  • Machinery
  • Mobile Plant
  • Gas Bottles
  • Hot Work
  • Fire
  • Explosion
  • Eye
  • Hearing
  • Unstable Object
  • Animals

Signage and Site Access

• Warning signs and hazard board displayed.

  Yes

  No

  N/A

• Site access control and induction in place.

  Yes

  No

  N/A

• Current SSSP available on site and evidence of use.

  Yes

  No

  N/A

Site General

• Workplace is tidy and orderly, free of trip hazards.

  Yes

  No

  N/A

• No excessive dust, noise, heat and surface water.

  Yes

  No

  N/A

• Waste is segregated and managed appropriately.

  Yes

  No

  N/A

• Exposed reinforcing bars are capped.

  Yes

  No

  N/A

• Traffic management is provided.

  Yes

  No

  N/A

PPE and Manual Handling

• PPE is used in accordance with the hazard board

  Yes

  No

  N/A

• Specialist PPE is used where required

  Yes

  No

  N/A

• Acceptable manual handling for the tasks observed

  Yes

  No

  N/A

Working at Heights

• Fall hazards identified and suitably barriers in place.

  Yes

  No

  N/A

• No Elevated Work observed within 4 metres of power lines.

  Yes

  No

  N/A

• Ladders in use meet Work Instruction guidelines.

  Yes

  No

  N/A

• Scaffold in use meets Work Instruction guidelines.

  Yes

  No

  N/A

Electrical Hazards

• Power supplies have RCD protection

  Yes

  No

  N/A

• Leads have valid test tags, are in good condition, dry.

  Yes

  No

  N/A

• Other considerations.

  Yes

  No

  N/A

Hazardous Substances

• Management of asbestos complies with acceptable practice.

  Yes

  No

  N/A

• Management of lead-based complies with acceptable practice.

  Yes

  No

  N/A

• Management of other hazardous substances is in line with acceptable practice.

  Yes

  No

  N/A

Other Observations

• Record any other significant observations, including conversations with site personnel.

Observation Summary

• Does site management comply with HNZ’s requirements, SSSP?

  Yes

  No

• If ‘No’, identify corrective action required, and carry forward summary to Site Visit Report form.

Attached forms:

• Hazard Self-assessment

• Health and Safety Observation

• Observations / Work in Progress

• Personnel, Plant and Equipment on Site

• Communications with Contractor

• Health and Safety Observations

• Actions Required