Information
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Project Work Order Number
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Reinstatement Address
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Conducted on
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Prepared by
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Job/task number / purchase order number
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Customer
- Fulton Hogan
- Southeast Water
- Lendlease
- Frasers
- Bitumill
- Other
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Emergency assembly location
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First Aid Officers Present
- Peter Henderson
- Scott Henderson
- Jake Hardy
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JSEA/SWMS available on site
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Water available
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Separation distance 3m from all Machinery
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Maintain eye contact with machinery operators when moving around machinery
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Site Safety Risk Assessment
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Overhead power lines / obstructions
- spotter
- Yellow cones
- Maintain safe distance from power lines
- Cover or barricade
- nominate safe working distance
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Open pits / ditches / culverts
- spotter
- Yellow cones
- Maintain safe distance from power lines
- Cover or barricade
- nominate safe working distance
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Uneven ground (profiled edges, back of kerb and channel)
- spotter
- Yellow cones
- Maintain safe distance from power lines
- Cover or barricade
- nominate safe working distance
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Steep grades (more than 1-10)
- chock parked vehicles
- maintai safe distance from pant and people
- use experienced personnel for site conditions
- Brief and closely supervise trainees to gain experience
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Traffic
- ensure traffic is set up in accordance with TMP
- Nominate traffic separation distances
- Traffic speed >60kph min 3m clearance required
- Traffic speed <60kph min 1.2 Clearance required
- <1.2 metre clearance distance traffic must be dropped to 40kph and traffic stopped by traffic controller with stop/slow sign so traffic is controlled through work zone
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Pedestrians public / ground personnel
- ensure traffic is set up in accordance with TMP
- Nominate traffic separation distances
- Traffic speed >60kph min 3m clearance required
- Traffic speed <60kph min 1.2 Clearance required
- <1.2 metre clearance distance traffic must be dropped to 40kph and traffic stopped by traffic controller with stop/slow sign so traffic is controlled through work zone
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Schools
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Control measure
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Fall hazard &/or working at >2m
- Three points of contact when entering and exiting machines and trucks
- discussed at toolbox
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Control measure
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Weather conditions (heat / rain etc)
- greater than 35 deg
- Rain
- Showers
- Less than 12 deg
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Control measure
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Other contractors/activities onsite
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Control measure
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Are other controls needed to manage environmental issues? -flora & fauna -dust -noise -contaminated run off
- leave native fora and fauna habitats unaffected by ongoing works
- clean up and remove all oil, fuel and other chemical spills
- maintain on site spill kits
- block drainage points
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Have all employees and subcontractors been inducted to the principal contractors site induction
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Have subcontractors been inducted into site specific prestart
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Are all machine/plant operators licensed and competent ? If not trainees must have completed the initial machine induction & will be supervised for machine/plant operating
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Have plant daily pe-start sheets been completed for all mobile plant including subcontractors
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Is traffic management (TPM) available and traffic control set up in accordance with TMP?
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Are all personnel provided with appropriate PPE for task undertaken?
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Other control measures needed
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Site induction record - all personnel (including subcontractors personnel)
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Name
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Warren Yarker
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Kallan Fabris
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Peter Henderson
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Jake Hardy
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Shane Woolley
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Scott Henderson
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Ray Sewick
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Jason Collins
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Harley Morrone
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Paul Hatsiz
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Scott Thompson
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Add signature
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Add signature
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Add signature
Reinstatement 1
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Type
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Length (m)
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Width (m)
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Depth mm
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Preconstruction Photo 1
Reinstatement 2
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Type
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Length (m)
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Width (m)
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Depth mm
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Preconstruction Photo
Reinstatement 3
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Type
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Length (m)
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Width (m)
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Depth mm
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Preconstruction Photo
Other
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Comments (extra reinstatement patches, odd ball sizes, coloured concrete, etc)
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Traffic Required?
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Signed