Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Water Authority Validation Officer present?

  • Tap to enter information
  • Personnel

Site overview

  • Inspection carried out the following time

  • Select date

  • Principal Contractor

  • Watermain Contractor

  • Number of workers on site

  • Weather

  • Site conditions

  • Additional site conditions:

  • All actions from previous inspection report completed

Watermains Construction

  • Correct pipe class/in date

  • Bedding material complies and is sufficient depth

  • Bedding material documentation recorded - Supplier, Receipt, Number & Quantity

  • Watermains have sufficient clearances from other services

  • No connections on curved mains

  • Is plastic wrapping in place

  • Watermain depths accord with plans

  • Have the anchor blocks been poured to conform with the specifications

  • Kerb markings are correct

Watermains Management

  • Contractor has Project Management Plan onsite and up to date

  • Contractor has Safe Work Method Statement (SWMS) on site and up to date

  • Contractor has Inspection Test Plan on site and up to date

  • Contractor has Tool Box meeting minutes on site and up to date

  • Contractor has Site Induction requirements and documentation on site and up to date

  • Contractor has Approved up to date construction plan on site

  • Contractor has One call documentation on site and up to date

  • Nominated supervisor on site

O.H.S Checks

  • Red card

  • Traffic

  • Correct PPE Hats, Vests

  • Barricading

  • First aid

  • Power

  • Water

  • Toilets

  • General safety

Traffic control

  • Is traffic control required

  • Tap to enter information
  • Workmen ahead signage

  • Detour ahead signage

  • Arrow boards

  • Road closed signage

  • Is traffic management plan in place

  • Is VicRoads approval required/received

  • Are bollards being used in a reasonable manner

  • Is pedestrian access in place

Excavations / Trenching

  • Are there any excavation works

  • Tap to enter information
  • Is trenching/excavation > 1.5m deep

  • Edge protection & ladder access in place

  • Are shields being used

  • Is benching being used

  • Are road plates required and available

  • Are road plates in use

  • Is there a "Mine Managers" certificate holder on site

  • Is spoil away from edge of trench

  • Are the trenches backfilled if no more work is required

  • Is barricading suitable

  • Has allowance for underground services and protection been made

Confined Spaces

  • Is confined space entry required

  • Tap to enter information
  • Has permit to work been obtained

  • Is entry to a confined space required

  • Is signage in place

  • Do personnel have confined space entry ticket

  • Is breathing apparatus in use

  • Pits > 1.5 required for assessment

  • Is the SWIFT Form Q current for Sewer applications

Materials

  • Delivery / Handling / Storage

Temporary bench marks

  • Marked and maintained

Machinery

  • Is machinery in use

  • Tap to enter information
  • Does plant have flashing lights that are working and being used

  • Does plant have reversing beepers

  • Does plant have roll over cages / protection where required

  • Has provision for O/H services been allowed for

  • Are log books up to date

Environment

  • Runoff Controlled

  • Dust Controlled

  • Noise Acceptable

  • Tree Protection Zones in Test

Summary

  • Safety Advisors Comments

  • Photo Records:

  • Safety Advisor

  • Site Representative

  • I confirm that all actions highlighted within this report have been completed

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.