Title Page

  • Document No.

  • Job Reference

  • Job Reference Number:

  • Site Address:
  • Select date

  • Drivers Name:

  • Drivers mate:

  • Vehicle Reg:

Documentation/ Identification

  • Work Order(s) for Job(s)

  • Applicable RAMs

  • Log book

  • Vehicle Check/ Defect Sheet

  • Current Driving Licence

  • NRSWA Certification

Health and Safety

  • Hi Vis being worn

  • Safety boots being worn

  • Hard Hats being worn (if required)

  • Ear Protection being worn (if required)

  • Eye Protection being worn (if required)

  • Gloves being worn

  • First Aid Kit available/ complete/ in date

  • Fire Extinguisher available/ in date

Traffic Control (Chapter 8)

  • Safety zone(s) set up correctly

  • Photos of site set up

  • Signage set up correctly (clean/undamaged)

  • Signage correctly branded

  • Barriers and cones set up properly

  • Traffic lights set up correctly/ working properly

  • Stop/ Go boards available (Where required)

  • Pedestrian walkways/ ramps (Where required)

  • Tools/ equipment/ spoils within safety zone(s)

Other

  • Courtesy board on display/ clean/ correct info

  • Crew smart and presentable/appropriate PPE worn

  • Site/ operational area clean and tidy

  • Crew courteous to clients/ customers/ general public

Equipment

  • All plant/ equipment in good working order

  • Entry equipment inspected

  • Gas monitoring equipment calibrated

  • Electrical tools/ Extension leads PAT tested in date

  • Lifting equipment examined

  • All equipment identified/ status tagged/ labelled

  • All inspection/ test/ calibration records available

  • Faulty equipment labelled/ prevention of use

Environmental

  • Spill kits available/ complete

  • Vehicle/ plant free of oil leaks

  • Excessive exhaust/ other emmisions

  • Excessive noise

  • Excessive dust

  • Unacceptable odour(s)

  • Evidence of pollution/ contamination

  • Photos of Evidence

  • Pollution prevention measures in place

  • Evidence of environmental damage

  • Photos of Evidence

  • Adverse effect on ecology (animals/plant life)

  • Material data sheets available for chemicals

Vehicles

  • Vehicle(s) parked in safe/ permitted location(s)

  • Vehicle(s) clean/presentable (outside/inside)

  • Hydrant licence(s) on view

  • Pipes properly secured

  • Visible damage to vehicle

  • Photos of damage

  • Accident procedure/ forms

Tool Check

  • Ipad

  • Hammer

  • Crowbar

  • Adjustable Spanner

  • Lifters

  • Screw Driver

Additional

  • Duty of care paperwork done correctly

  • Comments/ problems/ defects/ recommendations

  • Action to take

  • Auditors signature

  • Auditors name:

  • Drivers signature

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.