Allwater Networks job starts

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• time and date

  Date

If you answer YES to any of the following questions Refer to relevant Procedure

• Are you performing isolated work and do you need to activate lone worker provisions?

  Safe

  At Risk

  N/A

• Does your work involve hot works (grinding/welding/oxy cutting)?If yes do you have the correct equipment ? extinguishers

  Yes

  No

  N/A

• Is today deemed a fire ban day? If yes permit number is required

  Yes

  No

  N/A

• Fire ban permit number----

• Are Environmental impacts controlled?

  Yes

  No

  N/A

• Is this deemed a confined space?

  Yes

  No

  N/A

STEPS ask your work group

• Can I (we) slip, trip or fall, does the work zone contain uneven ground and/or kerbs?

  Yes

  No

  N/A

• Do I have adequate traffic management?

  Yes

  No

  N/A

• Is there sufficient space within the work space to safely complete the task?

  Yes

  No

  N/A

• Are there sharps objects within the work space eg spines on plants, needles, fences, pickets, loose corrugated iron etc?

  Yes

  No

  N/A

• Are there any obstructions with the work space preventing safe access eg building rubble shrubs demolition site etc..

  Yes

  No

  N/A

• Are there any other hazards (overhead cables, trees, etc?

  Yes

  No

  N/A

• Do you have adequate and appropriate PPE?

  Yes

  No

  N/A

• Is lighting sufficient to safely identify hazards and complete the task?

  Yes

  No

  N/A

• Do I have the correct equipment to avoid manual handling incident?<br>(Drill or valve actuator)

  Yes

  No

  N/A

• Can something fall on me?

  Yes

  No

  N/A

• Are all the tools and equipment in good condition?

  Yes

  No

  N/A

• Is the area tidy and safe?

  Yes

  No

  N/A

• Am I fit and competent for this task?

  Yes

  No

  N/A

• Are there any public safety issues?

  Yes

  No

  N/A

Are there uncontrolled hazards? If YES the hazards and controls must be identified below

• Issues/Hazards

• Issues/Hazards

• Issues/Hasards

• Issues/Hazards

• Photos of Issues/Hazards

  Media