Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
To be completed when undertaking site surveillance of work activity. Complete each section as applicable and sign and date at bottom. Use additional sheets if needed.
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Name
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Date
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Location
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Name of Person in Charge
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Number in Team
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Name of COSS / PC / ES (as applicable)
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Sentinel No
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(note – Detail of others on site can be taken from site briefing record (or attach copy)
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Detail of Work being undertaken
Immediate Observations - 1.Safety Arrangements in accordance with NR/L2/OHS/019
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Has a Site Brief been carried out? -Did the COSS/ES carry out the brief, has the information available to conduct the brief. -Was the briefing of a good quality and adequate for the task and location.
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Were you briefed on arrival on site?
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Were briefings given by the PIC? - The Person In Charge or the Controller of Site Safety?
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Was the briefing of a good quality and adequate for the task and location and type of Work? - Was the brief taken in a safe location? -Was the briefing detailed enough for the type of work that’s commencing?
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Is there a signed Safe Work Pack on site? - Signed by the PIC and RM
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Is the pack in date and suitable for location and type of work? - Was the Safe Work Pack dated for the works being carried out and state the correct location?
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Are Site arrangements consistent with those detailed in SWP? ~Is there a Person In Charge/COSS of the site? ~Have the risks associated with the work been identified and controlled? ~Have the team got the required Isolation forms, Permits associated with the work? is there sufficient First Aid, Fire, Welfare, Working at height etc?
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Are appropriate Task Risk Control Sheets or Risk Assessments available? ~Has the team conducting the work have a valid Risk Assessment or Task Risk Control sheet on site? Please state the reference number(s)
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Are all staff using appropriate PPE? - The type and additional requirements available and being worn in line with the task specific Risk assessment?
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Is the PPE being worn in good condition, is it clean, is it adequate, in line with the Task Risk Control Sheets/Risk Assessment and is it compatible with other PPE being worn
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Is the PPE Clean and in good Condition? - Is the PPE being worn in good condition, is it clean, is it adequate, in line with the Task Risk Control Sheets/Risk Assessment and is it compatible with other PPE being worn?
2.Work Content
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Does the team undertaking the task have the requisite competencies for the task? - Can the team produce the necessary Sentinel competency of Authority to Work for the task being conducted.
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Are tools and equipment being used and then stored correctly? Is all plant and equipment (e.g. machinery, power plant, ladders, strimmers, shovels, grinders) fit for purpose? Have they been tested, inspected or calibrated as necessary? Is plant and equipment stored correctly? If refuelling is necessary are staff aware of how to do this safely? Are the people using the plant currently competent? Check that the use of tools and equipment is not endangering the workgroup or passing train or resulting in damage to the infrastructure or asset?
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Does the task involve substances or activities hazardous to health? - ~Such as HAVS, Dust, fumes etc. ~Have the necessary Control measure been implemented and controlled in line with AKI Procedures?
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If there are any hazards to health, then are there suitable exposure monitoring arrangements in place? -If not, the Task must be stopped!
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Are all necessary permits and permissions in place for the work to be undertaken?<br>-Such as Permits to dig, working at heights, Isolation form C, etc Please state all permits needed and being used?
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Additional Observations<br>-This section is to provide additional information on the task or process the team are undertaking?
3. Unsafe conditions or acts
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Did you observe/note any unsafe act? -If so, provide details. Has the unsafe act(s) been corrected? If not, stop the act and raise an action.
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Did you observe/note any unsafe act? -If so, provide details. Has the unsafe act(s) been corrected? If not, stop the act and raise an action.
Overall summary of findings
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Overall summary of findings
Authority to Work - Competence Criteria Observed (add observed Employee Name and Criteria)
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Authority to Work - Competence Criteria Observed (add observed Employee Name and Criteria)
ACTIONS
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Detail of action to be taken
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By Who?
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Date?
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Signed
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(Print Name)
