Information

  • Client / Site

  • Prepared by

  • Conducted on

  • Location
  • Document No.

  • Location/Area Inspected

1.0 Work Areas

  • 1.1 Digger face height are within safe working ranges

  • 1.2 Adequate turning area for plant, i.e. trucks, etc.

  • 1.4 Lighting is adequate for night shift

  • 1.5 All bunds are appropriate sizes

  • 1.6 All signage in place

  • 1.7 LV park up in safe location

  • 1.8 Above and below work area are controlled

  • 1.9 Open excavations are barricaded and have signs

  • 1.10 Geotechnical hazards are eliminated and controlled

  • 1.11 JHA and permits in place and being followed

  • 1.12 TMP in place (muster point signs erected)

  • 1.13 All works are within clearing boundaries

2.0 Roads

  • 2.1 Correct road width

  • 2.2 Stability (no soft spots or slumping)

  • 2.3 Drainage (no wet areas)

  • 2.4 Adequate signage (intersections, dump areas, delineation)

  • 2.5 windrows installed and at correct hieghts

  • 2.6 Good visibility at all intersections

  • 2.7 All ramps at appropriate grades

  • 2.8 Access roads (to and from work area)

3.0 Vehicle/Plant

  • 3.1 LV and HV interactions are minimised

  • 3.2 Traffic flow known to all site personnel

  • 3.3 Load and haul interactions are minimised

  • 3.4 Lighting plants have adequate bunding

4.0 HV Park Up

  • 4.1 Adequate signage

  • 4.2 Adequate operator access

  • 4.3 Access for service vehicles

  • 4.4 Vehicle parked correctly (chocked, 'V' drain)

5.0 Dumps

  • 5.1 Bunds and windrows are appropriate height

  • 5.2 Dump height appropriate

  • 5.4 Stability of area

  • 5.5 LV park up area in safe location

  • 5.6 Correct signage in place

  • 5.7 Adequate lighting for night shift

6.0 Environment

  • 6.1 Waste bins labelled and in correct place

  • 6.2 Stockpiles are placed away from water ways and protected areas

  • 6.3 Clearing has been undertaken in a progressive manner

  • 6.4 Excess dust has been controlled and not interfering with other works

  • 6.5 LV's and HV's have no black smoke emissions

  • 6.6 No visible evidence of erosion within stockpiles

  • 6.7 Areas to be cleared are clearly demarcated, i.e. flagging, survey pegs, etc.

  • 6.8 All permits are relevant and in date

  • 6.9 All leaks and spills have been cleaned up and reported

  • 6.10 Spill kits available

  • Positive Feedback

  • Supervisor Signature

Email to site safety department.

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.