1.0 Site Information
Date and Time
Worksite Location including start and finish KM:
Location of work in rail corridor?

Description of work being carried out?

2.0 Induction

Safety induction given to auditor(s)?

Rate the quality of the induction (where 1 is inadequate and 5 is excellent)

PWB form used is current?

PWB form properly compiled with all fields completed?

All signatures shown on PWB form?

WPP form current?

WPP form properly compiled with track diagram showing work areas, protection arrangements and safe areas?

All persons have appropriate PPE?

Emergency evacuation procedures explained?

Detonator register observed?


3.0 Worksite Protection Details

Protection Officer's (PO) name:

What worksite protection is in use?
What adjacent line protection is in use?
4.0 Protection details LPA

Safe Notice circular notice?

Detonators, red flags/lights at both ends of possession or 2500m from worksite as required by network rules?

Protecting signals placed at stop with blocking facilities applied?

Remarks / Comments:

5.0 Safeworking Documentation

Are the current Work Method Statements / Safe Work Breakdowns on site?

If no, give details:

Have the workers been briefed on, and are they up to date with any changes to the relevant WMS/SWB?

If no, give details:

Remarks / Comments:

6.0 Protection Officer's Diary and Log

Has the Protection Officer compiled the Protection Officer's Diary (POD) and the Protection Officer's Log (POL), where required?

Remarks / Comments:

7.0 General Summary

Has a Worksite Protection Plan or similar document been compiled and signed by all relevant persons?

Was the Worksite Protection Plan reviewed as part of the pre work brief?

Can workers demonstrate knowledge of Work Method Statement / Safe Work Breakdown?

Can workers demonstrate knowledge of the Worksite Protection Plan?

Has the site induction register been completed correctly?

Do controls listed in the Pre Work Brief appear on the Worksite Protection Plan (eg safe places)?

Was a Pre Work Briefing form completed and signed by site workers?

Has the latest version of Pre Work Brief form used? (As per ARTC website)

Were you as an observer inducted into the site?

Did you sign the Pre Work Brief form?

Can the workers identify the Safe Place?

Do the workers know who is the First Aid Officer?

Is the first aid kit(s) on hand and appropriately stocked?

Is the planning of the work adequate?

Is lighting adequate for activity?

Are holes/excavations barricaded?

Is perimeter of worksite guarded / fenced / gates secured?

Are amenities adequate?

Are detonators in storage or use within recommended shelf-life?

Remarks / Comments:

Auditor name:

Other persons involved (if required):

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.