Information

  • Project Work Order Number

  • Reinstatement Address
  • Conducted on

  • Prepared by

  • Select date

  • Address
  • Job/task number / purchase order number

  • Customer

  • Prestart record completed by

  • Emergency Assembly Location

  • First Aid Officers Present

  • JSEA/SWMS available on site

  • Water available

  • Site Safety Risk Assessment

  • Overhead power lines / obstructions

  • Control measure

  • Open pits / ditches / culverts

  • Control measure

  • Uneven ground (profiled edges, back of kerb and channel)

  • Control measure

  • Steep grades (more than 1-10)

  • Control measure

  • Traffic

  • Control measure

  • Pedestrians public / ground personnel

  • Control measure

  • Schools

  • Control measure

  • Fall hazard &/or working at >2m

  • Control measure

  • Weather conditions (heat / rain etc)

  • Control measure

  • Other contractors/activities onsite

  • Control measure

  • Are other controls needed to manage environmental issues?<br>-flora & fauna<br>-dust<br>-noise<br>-contaminated run off

  • Control measure

  • Have all employees and subcontractors been inducted to the principal contractors site induction

  • Have subcontractors been inducted into site specific prestart

  • 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

  • Have plant daily pe-start sheets been completed for all mobile plant including subcontractors

  • Is traffic management (TPM) available and traffic control set up in accordance with TMP?

  • Are all personnel provided with appropriate PPE for task undertaken?

  • Site induction record - all personnel (including subcontractors personnel)

  • Name

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

Reinstatement 1

  • Type

  • Length (m)

  • Width (m)

  • Depth mm

  • Preconstruction Photo 1

Reinstatement 2

  • Type

  • Length (m)

  • Width (m)

  • Depth mm

  • Preconstruction Photo

Reinstatement 3

  • Type

  • Length (m)

  • Width (m)

  • Depth mm

  • Preconstruction Photo

Other

  • Comments (extra reinstatement patches, odd ball sizes, coloured concrete, etc)

  • Traffic Required?

  • Signed

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.