Title Page
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Conducted on
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Prepared by
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Location
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Location Name
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Name of worker/ workers being inspected?
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Description of task being undertaken by workers?
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Picture of area of works for reference (if allowed)
Works preliminary Q&A
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Has a JSA been signed and completed prior to works being conducted?
- Yes
- No
- N/A
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Were these works covered in the days pre start?
- Yes
- No
- N/A
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Has job specific SWMS been prepared, approved, and signed onto?
- Yes
- No
- N/A
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Has all client side requirements been submitted, approved, and completed?
- Yes
- No
- N/A
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Are the works a high risk activity?
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Have CV relevant works permissions/ permits been completed?
- Yes
- No
- N/A
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Have Client side permissions/ permits been completed?
- Yes
- No
- N/A
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Do CV Field workers hold relevant competancies?
- Yes
- No
- N/A
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Has CV Asset Services HSE Advisor been included and or approved these works?
- Yes
- No
- N/A
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Are all relevant isolations in place?
- Yes
- No
- N/A
Works specific Q&A
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Do field staff involved have appropriate personal protective equipment?
- Yes
- No
- N/A
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Are equipment and tools onsite fit for purpose and appropriate for task at hand?
- Yes
- No
- N/A
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Are there any hazards identifiable? If answer is Yes, stop works immediately and make safe, notify manager if applicable.
- Yes
- No
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Has all equipment on site been tested, tagged and or inspected? If NO, stop using equipment and rectify the issue
- Yes
- No
- N/A
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Is area of works free of slip trip hazards? ie housekeeping, tools, equipment?
- Yes
- No
- N/A
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Has the scope of works been delivered by either client, LH, or manager and understood?
- Yes
- No
- N/A
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Are all relevant plans, drawings, written scope and or works plans on site or discussed?
- Yes
- No
- N/A
Required Actions
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Are there any further actions required?
- Yes
- No
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Is further HSE consultation required?
- Yes
- No
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Any further notes based off findings?
- Yes
- No
