CBDA Safety Inspection Form (F281) Rev 2

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safety Inspection Checklist

• Verify workers in the area are project inducted (provide 3 names with induction numbers).

  Complies

  Non-Compliant

  N/A

• Verify workers are signed onto SWMS (take picture of sign on sheet).

  Complies

  Non-Compliant

  N/A

• Verify workers attended daily pre start (take picture of sign on sheet).

  Complies

  Non-Compliant

  N/A

• Verify workers workers are signed onto start / JHA card.

  Complies

  Non-Compliant

  N/A

• Verify VMP in place, adequate for the works and comunicated.

  Complies

  Non-Compliant

  N/A

• Check all workers wearing PPE.

  Complies

  Non-Compliant

  N/A

• Check item of plant in use has a current project sticker (take photo) and has no safety concerns.

  Complies

  Non-Compliant

  N/A

• Verify operator competency (take photo).

  Complies

  Non-Compliant

  N/A

• Verify operator has carried out the daily pre start for the item of plant (take photo)

  Complies

  Non-Compliant

  N/A

• Verify their is adequate controls for plant people segregation.

  Complies

  Non-Compliant

  N/A

• If working near roadway, verify a TCP/IP and ROL are in place and are being followed

  Complies

  Non-Compliant

  N/A

• Does any of the works require a permit? If so, are the requirements in place.

  Complies

  Non-Compliant

  N/A

• Is their adequate signage? I.E speed, first aid, radio channel.

  Complies

  Non-Compliant

  N/A

• Are their adieu ate amenities and facilities? (Toilets, drinking water, first aid etc).

  Complies

  Non-Compliant

  N/A

• Additional hazards

  Complies

  Non-Compliant

  N/A