Title Page

  • Document Reference:

  • ARTC Business Unit/ Department (e.g. Hunter Valley Corridor Works):

  • Inspection conducted:

  • Working Environment:

  • Closedown Job Number (if applicable)

  • Contractor and Activity being undertaken:

  • Principal Contractor:

  • Observations and Report generated by:

Site information

  • Date:

  • Location:
  • Location/ Section:

  • KM from:

  • KM to:

  • Type of work:

  • Company:

  • ARTC Site Supervisor:

  • Contractor Site Supervisor:

  • R.I.W. Card #:

  • Photo of R.I.W. Card:

  • Protection Officer:

  • PO Level:

  • R.I.W. Card #:

  • Photo of R.I.W. Card:

Certificates of Competency:

  • Photo of R.I.W. Card:

  • Photo of R.I.W. Card:

  • Photo of R.I.W. Card:

  • Photo of R.I.W. Card:

  • Photo of R.I.W. Card:

  • Photo of R.I.W. Card:

  • Worker Role must be ACTIVE within Onsite Trackeasy. If Role not ACTIVE - Cease Works Immediately.

Pre Start/ Pre Work Brief/ PO Brief

  • Has the following Safety critical information been Communicated and Documented as per "Pre Work Brief SA-WI-02-010"?

  • Scope, date and location of works?

  • Weather Conditions?

  • Name and Signature of Responsible Person conducting the briefing?

  • Location and Time of Briefing?

  • Whether the Qualified Safe Worker has provided a briefing or not?

  • First aider's Name and Location of First Aid kit/s?

  • What form the Warning Alarm will be?

  • Network Controllers Emergency Number?

  • Asked whether free of effects of Drugs, Alcohol and Fatigue?

  • Has the Pre Work Brief been Communicated clearly and easily understood?

  • Comments (optional):

  • Have relevant Worksite Hazards been identified?

  • Comments (optional):

  • Has the PO Brief included appropriate Hazards and Controls?

  • Comments (optional):

  • Has the PO Diary been completed with Safety critical information?

  • Comments (optional):

  • Type of Worksite Protection?

  • Is Worksite Protection deemed appropriate for task being performed?

  • Comments (optional):

  • If "NO" to above - Stop Work! Risk Assessment Required!

  • Comments (optional):

Detonators (Safeworking Protection)

  • Are Detonators stored correctly and within expiry date?

  • Comments (optional)

  • Has the Detonator Register been filled out?

LPA Delineation (if applicable)

  • During an LPA, Delineation is required between Work Groups (based on Risk Assessment)

  • Has Delineation been placed between Work Groups?

  • Comments (optional):

  • If "NO" to above, Protection Officer to explain Risk Assessment, observer to ensure this is documented in PO Diary

  • Are you in agreement with this Risk Assessment?

  • If "NO" to above, Discussion Required.

  • Comments (optional):

Drug & Alcohol Testing

  • Has Drug testing been implemented on this worksite as per ARTC Drug and Alcohol Policy?

  • Number of workers tested (if applicable):

  • Has Alcohol testing been implemented on this worksite as per ARTC Drug and Alcohol Policy?

  • Number of workers tested (if applicable):

Protection Officer - Worksite Protection Plan

  • Has Worksite Protection Plan been completed correctly as per Worksite Protection Plan NO-WI-02-010?<br>* 5 Mandatory Safety Critical items needed:<br> - Reference to Capital City in top left hand corner<br><br> - An easily reached Safe Place<br><br> - Name of the track/s<br><br> - Worksite location defined whether in or not Danger Zone by KM or Crossover No. or Points No. or Signal No.<br><br> - The name of the stations either side of the worksite.

  • If "NO", additional detail or clarification required:

  • Do relevant Controls listed in Pre Work Brief appear on the Worksite Protection Plan?

  • If "NO", education required. Comments (optional):

  • Does Protection Officer have access to Network Rules and Procedures?

  • PO must have access to these Documents. Available via www.artc.com.au

  • Photo of PO Brief:

  • Photo of Worksite Protection Plan:

  • Photo of PO Diary:

Rail Level Crossings

  • Are any F-Type Level Crossings in the work area?

  • If "YES" to above has the F-Type Level Crossing been Booked Out using an IBA (Infrastructure Booking Authority)?

  • If an IBA is in place on a Crossing, has Rule ANGE218 (Type F Level Crossing Management) and Procedure ANPR715 (Protecting F-Type Level Crossings) been applied.

  • Crossing MUST be operated by a Hand Signaller Level 2 for duration of the IBA.

Workers Observations

  • Have all site personnel completed a Worksite Induction?

  • Have ALL relevant personnel signed the PO Brief?

  • Number of Personnel:

  • Have ALL relevant personnel signed the Pre Start?

  • Number of Personnel:

  • Does this number match the number of workers signed onto the PO Brief?

  • If "NO", Non-Conformance and Action required.

  • Comments (optional):

  • Have Work Method Statements been signed by relevant personnel for tasks being undertaken?

  • Comments:

  • Can Workers demonstrate knowledge of Work Method Statements?

  • Comments:

  • Can Workers demonstrate knowledge of Worksite Protection Plan?<br>Network Control Emergency Phone Number etc.

  • Comments:

  • Can Worker name one or more Hazards on the PO Brief and the Controls?

  • Comments:

  • Do the Workers know who the First Aid Officer is?

  • Comments:

  • Is there a First Aid Kit on site?

  • Location:

  • Are all personnel on site wearing appropriate PPE as required for the task?

  • Comments:

  • Is lighting adequate for the activity/ works?

  • Comments:

  • Is perimeter of worksite secure/ gates locked?

  • Comments:

  • Are amenities adequate for the activity/ worksite?

  • Comments:

General Summary

  • Are the following documents available on-site?

  • Site Specific Safety Management Plan

  • Safe Work Method Statement/s relevant to task being performed.

  • Construction Environmental Management Plan

  • Task Based Environmental Impact Assessment.

  • Are there Hot Works being conducted on the Worksite?

  • Is there a Hot Works Permit in place?

Air Pollution

  • Are there visible dust emissions created by these work activities?

  • Comments:

  • Have dust emissions been suppressed effectively?

  • What type of Control is in place?

Water/ Land Contamination

  • Is it required on this site to include topics on environmental management and site environmental issues?

  • Comments:

  • Can workers demonstrate knowledge of environmental requirements and specific site sensitive areas?

  • Comments:

  • Are regular environmental site inspections carried out and documented by the contractor?

  • Comments:

  • Are all oils /fuels/ chemicals stored as documented in the CEMP (Construction Environmental Management Plan)

  • Are they stored away from waterways and drainage?

  • Comments:

  • Are Spill Kits readily available and easily identified on-site including at work locations?

  • Comments:

  • Are controls in place to ensure mud is not being tracked onto public roads or private property?

  • Comments:

  • Has Waste and Litter been contained in designated areas and is tested, classified, transported and disposed in cordons with relevant legislation?

  • If "NO", instruct Contractor to remedy.

  • Are Construction Hours restricted to 7am to 6pm Monday to Friday and 8am to 1pm Saturday? As per EPL (Environmental Protection License 3142) where work is occurring outside these work hours, has approval been sought and residents notified?

  • If different, please specify.

No Go Zones

  • Have required no-go zones been established and demarcated?

  • Heritage listed areas

  • Aboriginal and European protected areas

  • Endangered species

  • Flora and Fauna

  • Are they being adhered to?

Additional Comments / Site Photos

  • Comments

  • Site Photo 1

  • Site Photo 2

  • Site Photo 3

  • Site Photo 4

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.