CFMEU C & G Division - WA Branch Template

• Document No.

• Audit Title

• Employer/Builder

• Employer Representative/ Phone Number/ Position

• Site Address
  Address

• Conducted on

  Date

• Prepared by

Entry Permit

Name(s) of authorised representative of the Construction, Forestry, Mining and Energy Union of Workers -

• Date of entry -

  Date
• Project address -
  Address

• Entry under (tap to select) -

  s.49I of the Industrial Relations Act 1979 (WA)

• Was entry refused or delayed? (s 501 of the FW Act)

  Yes

  No

  N/A

• Have you been hindered or obstructed while exercising any rights? (s 502 of the FW Act)

  Yes

  No

  N/A

• So far as is reasonably practicable, the particulars of the suspected contravention to which this notice relates are -

• Signed -

  Sign

• Signed -

  Sign

Incident Report

• Date/Time of Incident -

  Date

• Principal Contractor -

• Sub-Contractor -

• Health and Safety Representative -

• Incident Type (tap to select) -

  Select Access/Egress Air Quality Amenities/Hygiene Asbestos Chemicals Concrete Pumps Confined Spaces Consultation Core Drilling/Concrete Cutting Cranes Demolition Dust Earth Moving Equipment Electrical Emergency Procedures Engineering EWP's Falls Fatigue Fire Forklifts Formwork Housekeeping Lifts/Hoists Lighting Manual Handling Noise Piling Plant Power/Hand Tools Pre-cast/Tilt-up Panels Pre-stressing/Post-tensioning Radiation Rigging Scaffolding Supervision Synthetic Mineral Fibres Traffic Management Training Trenching/Excavation

  • Access/Egress
  • Air Quality
  • Amenities/Hygiene
  • Asbestos
  • Chemicals
  • Concrete Pumps
  • Confined Spaces
  • Consultation
  • Core Drilling/Concrete Cutting
  • Cranes
  • Demolition
  • Dust
  • Earth Moving Equipment
  • Electrical
  • Emergency Procedures
  • Engineering
  • EWP's
  • Falls
  • Fatigue
  • Fire
  • Forklifts
  • Formwork
  • Housekeeping
  • Lifts/Hoists
  • Lighting
  • Manual Handling
  • Noise
  • Piling
  • Plant
  • Power/Hand Tools
  • Pre-cast/Tilt-up Panels
  • Pre-stressing/Post-tensioning
  • Radiation
  • Rigging
  • Scaffolding
  • Supervision
  • Synthetic Mineral Fibres
  • Traffic Management
  • Training
  • Trenching/Excavation

• Primary Cause (select one) -

  Select Fine Windy Raining/Wet Low Light Extreme Cold Extreme Heat

  • Fine
  • Windy
  • Raining/Wet
  • Low Light
  • Extreme Cold
  • Extreme Heat

• Secondary Cause (select one) -

  Select Access/Egress Air Quality Amenities/Hygiene Asbestos Chemicals Concrete Pumps Confined Spaces Consultation Core Drilling/Concrete Cutting Cranes Demolition Dust Earth Moving Equipment Electrical Emergency Procedures Engineering EWP's Falls Fatigue Fire Forklifts Formwork Housekeeping Lifts/Hoists Lighting Manual Handling Noise Piling Plant Power/Hand Tools Pre-cast/Tilt-up Panels Pre-stressing/Post-tensioning Radiation Rigging Scaffolding Supervision Synthetic Mineral Fibres Traffic Management Training Trenching/Excavation

  • Access/Egress
  • Air Quality
  • Amenities/Hygiene
  • Asbestos
  • Chemicals
  • Concrete Pumps
  • Confined Spaces
  • Consultation
  • Core Drilling/Concrete Cutting
  • Cranes
  • Demolition
  • Dust
  • Earth Moving Equipment
  • Electrical
  • Emergency Procedures
  • Engineering
  • EWP's
  • Falls
  • Fatigue
  • Fire
  • Forklifts
  • Formwork
  • Housekeeping
  • Lifts/Hoists
  • Lighting
  • Manual Handling
  • Noise
  • Piling
  • Plant
  • Power/Hand Tools
  • Pre-cast/Tilt-up Panels
  • Pre-stressing/Post-tensioning
  • Radiation
  • Rigging
  • Scaffolding
  • Supervision
  • Synthetic Mineral Fibres
  • Traffic Management
  • Training
  • Trenching/Excavation

• Description of Incident -

• Photos

  Media

• Medical Treatment Required (select one) -

  None

  First Aid on-site

  Hospital/Medical Centre

• Has the regulator been notified?

  Yes

  No

  N/A

• Did an Inspector attend site?

  Yes

  No

  N/A

• Were any notices issued?

  Yes

  No

  N/A

• Weather Conditions (select one) -

  Select Fine Windy Raining/Wet Low Light Extreme Cold Extreme Heat

  • Fine
  • Windy
  • Raining/Wet
  • Low Light
  • Extreme Cold
  • Extreme Heat

• Was the task classed as high risk construction work?

  Yes

  No

  N/A

• Was there a safe wok method statement prepared for the work?

  Yes

  No

  N/A

• Was the safe work method statement being followed?

  Yes

  No

  N/A

• Outcomes/Corrective Actions -

Site Requirements

• Photo of site signage -

  Media

• Is signage displayed on ALL sides and clearly visible from outside the workplace? (Building Services (Registration ) Regulations 2011 WA)

  Yes

  No

  N/A

• Does it display;

• The principal contractor's name and telephone contact number, Including after hours?

  Yes

  No

  N/A

• The location of the site office?

  Yes

  No

  N/A

• The presence of hazardous chemicals?

  Yes

  No

  N/A

• Is the site secured to prevent unauthorised access? (Section 21 Occupational Safety & Health Act 1984)

  Yes

  No

  N/A

• Are hazards isolated in the event of unauthorised entry occurring?

  Yes

  No

  N/A

• Have workers been site inducted? (Section 19 Occupational Safety & Health Act 1984)

  Yes

  No

  N/A

• Are induction records kept on site available for viewing?

  Yes

  No

  N/A

• Do all workers on site hold general construction induction cards?

  Yes

  No

  N/A

• Are all visitors inducted into site-specific risks?

  Yes

  No

  N/A

• Have necessary permits been obtained and are available on site? (Council, EPA, Regulator, Traffic etc)

  Yes

  No

  N/A

Management Responsibilities

• Has a OSH Management Plan been prepared for the workplace before commencement?

  Yes

  No

  N/A

• Does the plan include;

• Names, positions and responsibilities of all persons with OSH duties at the workplace?

  Yes

  No

  N/A

• Arrangements for consultation, co-operation and co-ordination at the workplace?

  Yes

  No

  N/A

• Arrangements for managing any work health and safety incidents that occur?

  Yes

  No

  N/A

• Site-specific safety rules, and arrangements for ensuring all persons are informed?

  Yes

  No

  N/A

• Arrangements for collecting, assessing and reviewing SWMS?

  Yes

  No

  N/A

• Are safe work method statements prepared for high risk construction work? Meaning of “high risk construction work”<br><br>In this Chapter, high risk construction work means construction work that:<br>(a) involves a risk of a person falling more than 2 metres, or<br>(b) is carried out on a telecommunication tower, or<br>(c) involves demolition of an element of a structure that is load-bearing or otherwise related to the physical integrity of the structure, or<br>(d) involves, or is likely to involve, the disturbance of asbestos, or<br>(e) involves structural alterations or repairs that require temporary support to prevent collapse, or<br>(f) is carried out in or near a confined space, or<br>(g) is carried out in or near:<br> (i) a shaft or trench with an excavated depth greater than 1.5 metres, or<br> (ii) a tunnel, or<br>(h) involves the use of explosives, or<br>(i) is carried out on or near pressurised gas distribution mains or piping, or<br>(j) is carried out on or near chemical, fuel or refrigerant lines, or<br>(k) is carried out on or near energised electrical installations or services, or<br>(l) is carried out in an area that may have a contaminated or flammable atmosphere, or<br>(m) involves tilt-up or precast concrete, or<br>(n) is carried out on, in or adjacent to a road, railway, shipping lane or other traffic corridor that is in use by traffic other than pedestrians, or<br>(o) is carried out in an area at a workplace in which there is any movement of powered mobile plant, or<br>(p) is carried out in an area in which there are artificial extremes of temperature, or<br>(q) is carried out in or near water or other liquid that involves a risk of drowning, or<br>(r) involves diving work.

  Yes

  No

  N/A

• Are SWMS readily accessible and set out in a way that is easy to understand?

  Yes

  No

  N/A

• Are arrangements in place to ensure SWMS are complied with?

  Yes

  No

  N/A

• Is high risk construction work performed in accordance with SWMS?

  Yes

  No

  N/A

• Has work been stopped immediately and resumed only in accordance with the SWMS?

  Yes

  No

  N/A

Consultation

• Are there methods for consultation in place? (s.19(1)(c) Occupational Safety & Health Act 1984)

  Yes

  No

  N/A

• Are workers being consulted about ALL matters affecting their health & safety?

  Yes

  No

  N/A

• Is there an up to date list of HSR's displayed?

  Yes

  No

  N/A

• Have HSR's requested and completed training within 12 months of making request?

  Yes

  No

  N/A

• Is there a site safety committee? (s.36 Occupational Safety & Health Act 1984)

  Yes

  No

  N/A

• Is at least half of the committee made up of workers not nominated by the Main Contractor

  Yes

  No

  N/A

• Are names displayed in a prominent place?

  Yes

  No

  N/A

• Are minutes from safety committee meetings posted at the workplace?

  Yes

  No

  N/A

• Are HSR's and/or safety committee being notified and included in incident investigations? (s.33 (1)(b) Occupational Safety & Health Act 1984 )

  Yes

  No

  N/A

• Are health & safety concerns being addressed and closed out?

  Yes

  No

  N/A

• Are regular safety walks being conducted? (s.33(1)(a) Occupational Safety & Health Act 1984)

  Yes

  No

  N/A

• Are any Provisional Improvement Notices (PIN) issued by HSR's displayed in a prominent place?

  Yes

  No

  N/A

• Has the Improvement Notice been complied with in the specified time? (s.51 AG of the Occupational Safety & Health Act 1984)

  Yes

  No

  N/A

Amenities

• Are there adequate amenities for all workers on site? (Section 3.20 Occupational Safety & Health Regulations 1996)

  Yes

  No

  N/A

• Are amenities hygienic, ventilated and well lit? (Section 3.15 Occupational Health & Safety Regulations 1996)

  Yes

  No

  N/A

• Is there 1m2 available to seat each worker at one time? (Code of Practice First Aid Facilities services Workplace Amenities and Facilities )

  Yes

  No

  N/A

• Are there enough toilets to suit 1 per 10 males? (Building Code Australia BCA)

  Yes

  No

  N/A

• Are there enough urinals to suit 1 per 20 males, or 600mm of trough each? (Building Code Australia BCA )

  Yes

  No

  N/A

• Are there enough toilets to suit 1 per 10 females? (Building Code Australia BCA )

  Yes

  No

  N/A

• On multi-storey buildings are toilets located on at least every third floor? (EBA Provisions)

  Yes

  No

  N/A

• Are toilets clean, hygienic, well lit and easily accessible?

  Yes

  No

  N/A

• Are there enough hand-washing basins provided (Section 2.2 Occupational Safety & Health Regulations 1996)

  Yes

  No

  N/A

• Do workers have easy access to cool, clean drinking water? (Section 3.16 Occupational Safety & Health Regulations )

  Yes

  No

  N/A

• Are workers required to change in and out of clothes?

  Yes

  No

  N/A

• Are change rooms clean, hygienic and well lit?

  Yes

  No

  N/A

• Are change rooms a comfortable temperature for workers to change in?

  Yes

  No

  N/A

• Is there enough seating for workers to get changed?

  Yes

  No

  N/A

• Does the work undertaken require showers to be supplied?

  Yes

  No

  N/A

• Is there at least 1 shower for every 10 workers?

  Yes

  No

  N/A

• Do showers have a clean, slip-free surface?

  Yes

  No

  N/A

• Is there a floor area of at least 1.8m2?

  Yes

  No

  N/A

• Is there a dressing area containing a seat and hooks?

  Yes

  No

  N/A

• Does every shower have a lockable door?

  Yes

  No

  N/A

First Aid

• Is there adequate first aid facilities at the workplace? (Section 3.12 Occupational Safety & Health Regulations 1996)

  Yes

  No

  N/A

• Are first aid locations clearly signed and marked?

  Yes

  No

  N/A

• Are there enough trained first aiders as per risk assessment

  Yes

  No

  N/A

• Do workers have an effective means of communicating with first aiders such as 'nurse calls'?

  Yes

  No

  N/A

• Is there a first aid room? (Section 3.12 (2) Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Is the room hygienic, ventilated and well lit?

  Yes

  No

  N/A

• Is there adequate first aid equipment?

  Yes

  No

  N/A

• Is there an Automated External Defibrillator (AED) on site?

  Yes

  No

  N/A

• On multi-storey buildings is there a first aid kit on every second floor?

  Yes

  No

  N/A

• Is the first aid kit regularly checked and restocked?

  Yes

  No

  N/A

• Are first aid records kept on site?

  Yes

  No

  N/A

• Are first aiders and witnesses to serious incidents provided with counselling services?

  Yes

  No

  N/A

Emergency Plan

• Has an Emergency Plan been prepared and implemented at the workplace? (Section 3.10 Occupational Safety & Health Regulations 1996)

  Yes

  No

  N/A

• Have the workers been consulted on the preparation of the Emergency Plan?

  Yes

  No

  N/A

• Does the site have;

• An effective response to an emergency?

  Yes

  No

  N/A

• Is there a Fire Warden Structure on site? (AS 3745-2010, 5.7)<br>

  Yes

  No

  N/A

• Are there backup procedures in place in the event key personnel are absent or effected? (AS 3745-2010, 5.6.5)

  Yes

  No

  N/A

• Is anyone assigned to check areas to determine all people have been evacuated? (AS 3745-2010, 4.2.6.1)

  Yes

  No

  N/A

• Are there restrictions on plant, machinery and vehicular movement during an emergency? (AS 3745-2010, 4.2.19)

  Yes

  No

  N/A

• Are there multiple or alternate assembly areas in the event the primary mustering point is unsuitable? (AS 3745-2010, 4.2.6.5)

  Yes

  No

  N/A

• Evacuation procedures? (Section 3.10 Occupational Health & Safety Regulations 1996 )

  Yes

  No

  N/A

• Is there an Evacuation Diagram posted in prominent places at a height between 1200mm and 1600mm above the ground? (AS 3745-2010, 3.5)

  Yes

  No

  N/A

• Does the Evacuation Diagram contain;

• An accurate pictorial representation of the floor area? (AS 3745-2010, 3.5.5a)

  Yes

  No

  N/A

• The title 'EVACUATION DIAGRAM'? (AS 3745-2010, 3.5.5b)

  Yes

  No

  N/A

• The 'YOU ARE HERE' location? (AS 3745-2010, 3.5.5c)

  Yes

  No

  N/A

• The designated exits marked in green? (AS 3745-2010, 3.5.5d)

  Yes

  No

  N/A

• Fire extinguishers, hose reels, blankets, and hydrants marked in red? (AS 3745-2010, 3.5.5)

  Yes

  No

  N/A

• The location of assembly areas? (AS 3745-2010, 3.5.5m)

  Yes

  No

  N/A

• A legend reflecting all the symbols and colours used? (AS 3745-2010, 3.5.5n)

  Yes

  No

  N/A

• Processes for notifying emergency services?

  Yes

  No

  N/A

• Provisions for medical treatment and assistance?

  Yes

  No

  N/A

• Effective communication between the Main Contractor and all persons at the workplace?

  Yes

  No

  N/A

• Frequency for testing of emergency procedures?

  Yes

  No

  N/A

• Information, training and instruction for ALL workers in relation to implementing emergency procedures?

  Yes

  No

  N/A

• Has the emergency plan been maintained to ensure it remains effective?

  Yes

  No

  N/A

Emergency Preparedness

• Is all fire fighting equipment operational and free from obstructions?

  Yes

  No

  N/A

• Are extinguishers to suit Class A,B & C fires, located on each storey at every exit? (BCA Part E1.9)

  Yes

  No

  N/A

• Have extinguishers been tested at regular 6 month intervals? (AS 1851-2012, 1.11.1)

  Yes

  No

  N/A

• Are signs installed 2m above floor level showing the location of extinguishers? (AS 2444-2001, 3.3.4)

  Yes

  No

  N/A

• Are extinguishers mounted at a height of 1200mm maximum to the top and at least 100mm above the ground? (AS 2444-2001, f3.2)

  Yes

  No

  N/A

• Are extinguishers protected from aggressive environments such as sun, UV, wind, rain, dust or vibration? (AS 2444-2001, 3.9)

  Yes

  No

  N/A

• If the building has reached 12m, are the required hydrants and hose reels installed except the 2 uppermost storeys? (BCA Part E1.9)

  Yes

  No

  N/A

• Are required booster connections installed? (BCA Part E1.9)

  Yes

  No

  N/A

• Is there emergency backup lighting at a level of 20 lux for at least one hour? (c40-d i & AS 3012-2010, 2.7.3)

  Yes

  No

  N/A

• Is there battery backed up emergency evacuation signage in the event of power failure? (AS 3012-2010, 2.7.3)

  Yes

  No

  N/A

• Have ALL workers been trained to use fire fighting equipment on site? (c43-1c & AS 3745-2010, 6.3.3)

  Yes

  No

  N/A

Traffic Management

• Is there a site Traffic Management Plan in place? (AS 1742.3-2.2.2)

  Yes

  No

  N/A

• Does the plan include;

• Details of the works to be undertaken, impacts on the surrounding traffic and how those impacts will be addressed?

  Yes

  No

  N/A

• Separation for pedestrians and moving vehicles? (Section 3.22, 3.6, 3.7,Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• A Traffic Control Plan, where public and pedestrian traffic is affected?

  Yes

  No

  N/A

• Has the TCP been prepared by a suitably trained person?

  Yes

  No

  N/A

• Does it contain a diagram showing signs, devices, speed zones and pedestrian routes?

  Yes

  No

  N/A

• Are signs and devices set out as per the TCP?

  Yes

  No

  N/A

• Are traffic controllers required where changes to conditions affect traffic and pedestrians?

  Yes

  No

  N/A

• Are "PREPARE TO STOP" and "TRAFFIC CONTROLLER AHEAD" signs in place? (AS 1742.3, 3.5.2)

  Yes

  No

  N/A

• Do traffic controllers have certification from an RMS approved training course? (AS 1742.3, 4.10.6)

  Yes

  No

  N/A

• Are there an adequate number of traffic controllers to control one lane and one direction of traffic each? (AS 1742.3, 4.10.1)

  Yes

  No

  N/A

• Do traffic controllers have a clear escape route for emergencies?

  Yes

  No

  N/A

• Do traffic controllers have visual, audible communication with each other? (AS 1742.3, 4.10.2)

  Yes

  No

  N/A

• Are speed limits no more than 60km/h for a minimum of 150m? (AS 1742.3, 4.10.4)

  Yes

  No

  N/A

• Are traffic controllers wearing high visibility clothing? (AS 1742.3, 4.10.2)

  Yes

  No

  N/A

• Do traffic controllers have adequate breaks of 15 minutes every 2 hours, to manage fatigue? (AS 1742.3, 4.10.5)

  Yes

  No

  N/A

• A Vehicle Movement Plan for movement within the site? (Section 3.6 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Does the VMP contain a diagram showing signs, devices, travel paths, entries and exits as well as loading and unloading bays?

  Yes

  No

  N/A

• Requirements for vehicles on site, including maintenance, warning devices, guards and communication?

  Yes

  No

  N/A

• Review procedures for changing site conditions?

  Yes

  No

  N/A

• Is the plan being implemented and followed?

  Yes

  No

  N/A

• Are adequate safety barriers installed? (AS 1742.3, 2.4.5)

  Yes

  No

  N/A

• Are barriers installed as per manufacturers specifications and Australian Standards? (AS 3845, 2.4)

  Yes

  No

  N/A

• Are barriers inspected regularly to check for tampering, vandalism and damage? (AS 3845, 2.5)

  Yes

  No

  N/A

• Do non-rigid systems have protection to stop people or vehicles entering the deflection zone? (AS 3845, 4.2)

  Yes

  No

  N/A

• Are water-filled barriers fully filled as per manufacturers specifications?

  Yes

  No

  N/A

• Is there an exclusion zone set up to allow for the barrier deflection as per the manufacturers specifications?

  Yes

  No

  N/A

Site Security

• Is the site fully fenced to restrict unauthorised access? (AS 4687-2007)

  Yes

  No

  N/A

• Is the fencing stable both under normal and adverse conditions? (AS 4687-2007, 1.3)

  Yes

  No

  N/A

• Is temporary fencing installed within the boundaries of the worksite? (AS 4687-2007, 1.3)

  Yes

  No

  N/A

• Is fencing installed no more than three degrees out of plumb? (AS 4687-2007, 3.3)

  Yes

  No

  N/A

• Are all components in good condition and maintained to prevent injury to public? (AS 4687-2007, 1.4)

  Yes

  No

  N/A

• Are maximum infill spaces of mesh no bigger than 75mm? (AS 4687-2007, 2.1)

  Yes

  No

  N/A

• Are braces, counterweights and base plates installed as necessary? (AS 4687-2007, 2.1.7)

  Yes

  No

  N/A

• Are additional braces installed where signs or shadecloth have been installed? (AS 4687-2007, 3.7)

  Yes

  No

  N/A

• Baseplates are installed in a manner that doesn't provide a trip hazard or obstruct pedestrians? (AS 4687-2007, 3.8)

  Yes

  No

  N/A

• Are hoardings installed?

  Yes

  No

  N/A

• Is plywood a minimum of 12mm thick and painted? (AS 4687-2007, 2.2)

  Yes

  No

  N/A

• Has an engineer designed, inspected and signed off the hoarding? (AS 4687-2007, 2.2.4)

  Yes

  No

  N/A

• Have fences and hoardings been installed as per manufacturers recommendations and by a competent person? (AS 4687-2007, 3.1)

  Yes

  No

  N/A

• Are protections in place to prevent collision with the fence or hoarding? (AS 4687-2007, 3.2)

  Yes

  No

  N/A

Personal Protective Equipment

• Have workers been supplied with appropriate PPE? (Section 19 (d) (e) of the Occupational Health & Safety Act 1984, Division 2 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Have other control measures been implemented to reduce the amount of PPE needed? (Section 3.32 Occupational Health & Safety Regulations 1996 )

  Yes

  No

  N/A

• Have workers been consulted about the need for and type of PPE supplied?

  Yes

  No

  N/A

• Have workers been trained in the use and maintenance of the PPE? (Section 3.34 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Is the PPE suitable for the work, size, fit and comfort of the worker? (Section 3.34 (1) (b) Occupational Health & Safety Regulations 1996 )

  Yes

  No

  N/A

• Is storage provided for PPE?

  Yes

  No

  N/A

• Is the PPE maintained, repaired and replaced as needed?

  Yes

  No

  N/A

Work Areas

• Is there safe access and egress to and from work areas, both under normal conditions and an emergency? (Section 3.8 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Are there walkways to separate workers from moving plant?

  Yes

  No

  N/A

• Are access routes free of obstructions and stored materials?

  Yes

  No

  N/A

• Is access to and from work areas adequately lit to a minimum of 40lux? (AS/NZS 3012-2010, 2.7.1)

  Yes

  No

  N/A

• Are work areas adequately lit to a minimum of 160lux? (c40-d,i & AS/NZS 3012-2010, 2.7.1)

  Yes

  No

  N/A

• Is there enough space for workers to carry out work without risks to heath and safety?

  Yes

  No

  N/A

• Are the location of exits clearly marked and are there signs showing directions to exits posted?

  Yes

  No

  N/A

Hazardous Work

• Has a risk assessment been performed for hazardous manual tasks? (Section 3.1 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Has the duration and frequency of the task been assessed?

  Yes

  No

  N/A

• Have any environmental concerns affecting the task or the worker been assessed?

  Yes

  No

  N/A

• Have the systems of work been assessed?

  Yes

  No

  N/A

• Have workers been trained in correct manual handling techniques? (Section 3.1 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Are workers exposed to excessive levels of noise, either 8 hours above 85dB or 140dB peak? (Section 3.45 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Is exposure to noise being managed in accordance with the hierarchy of control?

  Yes

  No

  N/A

Electrical (AS/NZS :3012 Division 6 Occupational Safety & Health Regulations 1996 )

• Is electrical equipment regularly tested and tagged? (AS/NZS 3012-2010, 3.1)

  Yes

  No

  N/A

• Are records kept of all testing and tagging? (AS/NZS 3012-2010, 3.1)

  Yes

  No

  N/A

• Does wiring have protection against mechanical damage? (AS/NZS 3012-2010, 2.5.3)

  Yes

  No

  N/A

• Are switchboards readily accessible and protected from damage? (AS/NZS 3012-2010, 2.3.1.1)

  Yes

  No

  N/A

• Are switchboards marked so as to identify the source of supply? (AS/NZS 3012-2010, 2.3.1.1)

  Yes

  No

  N/A

• Are distribution boards located so no leads need to be run between levels? (AS/NZS 3012-2010, 2.3.1.2)

  Yes

  No

  N/A

• Is there suitable protection from damage/weather? (AS/NZS 3012-2010, 2.3.2.1a)

  Yes

  No

  N/A

• Are all live parts protected from contact with workers? (AS/NZS 3012-2010, 2.3.2.1c)

  Yes

  No

  N/A

• Are insulated 'tie bars' fitted for leads? (AS/NZS 3012-2010, 2.3.2.1d)

  Yes

  No

  N/A

• Do boards have lockable, hinged doors and means to hold in the open position? (AS/NZS 3012-2010, 2.3.2.1e)

  Yes

  No

  N/A

• Is there space for safe entry of leads and signage stating 'KEEP CLOSED - RUN ALL LEADS THROUGH BOTTOM'? (AS/NZS 3012-2010, 2.3.2.1e)

  Yes

  No

  N/A

• Are RCD's located inside the box with lockable covers to control resetting by unauthorised persons? (AS/NZS 3012-2010, 2.3.2.1)

  Yes

  No

  N/A

• Is there an accessible isolation switch? (AS/NZS 3012-2010, 2.3.2.1)

  Yes

  No

  N/A

• Are switchboards secured to prevent movement? (AS/NZS 3012-2010, 2.3.3)

  Yes

  No

  N/A

• Are all socket outlets protected by a 30mA RCD? (AS/NZS 3012-2010, 2.4.6.2)

  Yes

  No

  N/A

• Is all wiring protected against mechanical damage? (AS/NZS 3012-2010, 2.5.3)

  Yes

  No

  N/A

• Any suspended wiring is supported by means of a catenary and is suitably marked? (AS/NZS 3012-2010, 2.5)

  Yes

  No

  N/A

• There is no wiring is attached to temporary fence panels? (AS/NZS 3012-2010, 2.5.3)

  Yes

  No

  N/A

• Is temporary construction wiring labelled every 5m? (AS/NZS 3012-2010, 2.5.4)

  Yes

  No

  N/A

• Are leads no longer than 30m? (AS/NZS 3012-2010 T1)

  Yes

  No

  N/A

• Are non-conductive lead stands/hooks in use? (AS/NZS 3012-2010, 2.6.9)

  Yes

  No

  N/A

• No domestic rated power boards are in use? (AS/NZS 3012-2010, 2.6.12)

  Yes

  No

  N/A

• Is all unsafe electrical equipment disconnected or isolated and not reconnected until repaired?

  Yes

  No

  N/A

• Is there an electrical register of all equipment and testing kept on site? (AS/NZS 3012-2010, 3.10)

  Yes

  No

  N/A

Falls From Heights (Division 5 Occupational Safety & Health Regulations 1996 )

• Has a SWMS has been prepared where a worker can fall 2m or more?

  Yes

  No

  N/A

• Has a risk assessment been performed for all other heights? (Section 3.1 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Is the highest measure in the hierarchy of control being implemented?

  Yes

  No

  N/A

• Are control measures inspected and maintained?

  Yes

  No

  N/A

• Is edge protection securely fixed and installed as per the manufacturers specifications?

  Yes

  No

  N/A

• Is edge protection between 900mm and 1100mm high and contains a mid rail and toe-boards or mesh infill? (AS 4994.3-2010, 4.2.1)

  Yes

  No

  N/A

• Is edge protection positioned no more than 300mm from the outside edge? (AS 4994.3-2010, 4.2.1b)

  Yes

  No

  N/A

• Has the edge protection been inspected and a handover certificate provided? (AS 4994.3-2010, 5.3)

  Yes

  No

  N/A

• Are emergency and rescue procedures in place when using a fall arrest system?

  Yes

  No

  N/A

• Have all relevant workers been trained in the emergency procedures?

  Yes

  No

  N/A

• Have the emergency procedures been tested so that they are effective?

  Yes

  No

  N/A

• Does the installation of anchorage points comply with the manufacturers specifications? (AS/NZS 1891.4-2009)

  Yes

  No

  N/A

• Are warning signs in place highlighting the risk of falls?

  Yes

  No

  N/A

• Are penetrations covered immediately and securely fixed and marked?

  Yes

  No

  N/A

• Is cover strong enough to prevent persons or objects falling through?

  Yes

  No

  N/A

• Is roofing work being performed?

  Yes

  No

  N/A

• Is safety mesh installed as per manufacturers instructions? (AS/NZS 4389-1996)

  Yes

  No

  N/A

• Is mesh lapped 150mm and tied off 4-5 times on each longitudinal wire?

  Yes

  No

  N/A

• Are there control measures in place to minimise the risk of falling objects?

  Yes

  No

  N/A

Ladders

• Are ladders maintained and inspected regularly? (AS/NZS 1892.5-2000, 3.2)

  Yes

  No

  N/A

• Are all ladders rated for industrial use only of at least 120kg? (AS/NZS 1892)

  Yes

  No

  N/A

• Are ladders only used as a means of access and egress?

  Yes

  No

  N/A

• Are ladders secured from movement in all directions? (AS/NZS 1892.5-2000, 2.5)

  Yes

  No

  N/A

• Are ladders installed at the correct angle of 4:1? (AS/NZS 1892.5-2000, 2.3)

  Yes

  No

  N/A

• Are ladders only used on a firm level surface? (AS/NZS 1892.5-2000, 2.4)

  Yes

  No

  N/A

• Does the ladder extend at least 1m above the landing? (AS/NZS 1892.5-2000, 2.6)

  Yes

  No

  N/A

• Are three points of contact maintained at all times? (AS/NZS 1892.5-2000, 2.8)

  Yes

  No

  N/A

• Do trestle ladders have a platform width of at least 450mm?

  Yes

  No

  N/A

• No ladders are used on balconies?

  Yes

  No

  N/A

Scaffolding (Division 7 Occupational Safety & Health Regulations 1996 )

• Has written confirmation been received from a competent person stating that scaffolding over 4m is complete? (Section 3.72 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Has scaffold been inspected and signed off monthly, or following an incident or any alterations? (Section 3.72 (1) (a)

  Yes

  No

  N/A

• Is sign-off tag displayed in a conspicuous location? (AS/NZS 1576)

  Yes

  No

  N/A

• Are incomplete scaffolds appropriately closed and signage installed to prevent unauthorised access? (Section 3.70 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Has documentation been provided identifying the components and the supplier? (AS/NZS 1576.1-2010, 1.6.1)

  Yes

  No

  N/A

• Have instruction on erection, dismantling, servicing and inspection been provided? (AS/NZS 1576.1-2010, 1.6.1)

  Yes

  No

  N/A

• Does the documentation contain the weight of each component, duty loadings, maximum heights and number of working platforms? (AS/NZS 1576.1-2010, 1.6.1)

  Yes

  No

  N/A

• Are the design installation drawings available on site? (AS/NZS 1576.1-2010, 2.6.3)

  Yes

  No

  N/A

• Is scaffold erected on firm, level surface including the type of soleplates used? (AS/NZS 1576.1-2010, 2.9)

  Yes

  No

  N/A

• Have only compatible components been used? (AS/NZS 1576.1-2010, 2.4)

  Yes

  No

  N/A

• Are mesh/screens installed where objects can fall?

  Yes

  No

  N/A

• Are platforms slip resistant, free of trip hazards, and protected against uplift? (AS/NZS 1576.1-2010, 3.4)

  Yes

  No

  N/A

• There are no gaps in platforms greater than 10mm? (AS/NZS 1576.1-2010, 3.4)

  Yes

  No

  N/A

• Where materials are stored on a platform, there is unobstructed access of at least 450mm? (AS/NZS 1576.1-2010, 3.5)

  Yes

  No

  N/A

• Clear headroom of 1.85m is maintained on platforms? (AS/NZS 1576.1-2010, 3.7.4)

  Yes

  No

  N/A

• Working platforms are installed with transverse slopes of no more than 3 degrees? (AS/NZS 1576.1-2010, 3.8.1)

  Yes

  No

  N/A

• Access platforms installed at longitudinal slope of no more than 20 degrees? (AS/NZS 1576.1-2010, 3.8.2)

  Yes

  No

  N/A

• Has public protection been provided?

  Yes

  No

  N/A

• Is there adequate bracing installed, every third bay the full height of the structure?

  Yes

  No

  N/A

• Are ties at no more than 4m vertical intervals and within 2m of the top?

  Yes

  No

  N/A

• Are guardrailings, toeboards and mesh screens installed wherever a person or object could fall 2m or more? (AS/NZS 1576.1-2010 3.10.2)

  Yes

  No

  N/A

• The gap between the platform and the toeboard is no more than 10mm? (AS/NZS 1576.1-2010, 3.10.2.4)

  Yes

  No

  N/A

• Is there safe access and egress to and from working platforms? (AS/NZS 1576 3.6)

  Yes

  No

  N/A

• Is the gap between the working face of the scaffold and structure less than 225mm? (AS/NZS 1576.1-2010, 3.10.4.1)

  Yes

  No

  N/A

• Is the gap less than 100mm where it is not a working face? (AS/NZS 1576.1-2010, 3.10.4.1)

  Yes

  No

  N/A

• Is the surface of the floor no more than 300mm vertically from the platform? (AS/NZS 1576.1-2010, 3.10.4.2)

  Yes

  No

  N/A

• Are there self-closing access gates/hatches installed at top of ladders? (AS/NZS 1576.1-2010, 3.10.3)

  Yes

  No

  N/A

• Are stretcher stairs installed where required for emergency evacuation? (AS/NZS 1576.1-2010, 2.5.3.3.3)

  Yes

  No

  N/A

• Are ladders/stairs in good condition? (AS/NZS 1892)

  Yes

  No

  N/A

• Are ladders installed at 1:4 and secured against displacement in any direction? (AS/NZS 1892)

  Yes

  No

  N/A

Mobile Scaffolds

• Mobile scaffolds are erected by a competent person?

  Yes

  No

  N/A

• Are they built according to manufacturers specifications?

  Yes

  No

  N/A

• Is scaffold only accessed via an internal ladder?

  Yes

  No

  N/A

• Are wheels locked when in use? (AS/NZS 1576.1-2010, 3.12.1)

  Yes

  No

  N/A

• Are mobile scaffolds only used on a firm level surface? (AS/NZS 1576.1-2010, 3.12.3)

  Yes

  No

  N/A

• Scaffolds are not moved while people are on platform? (AS/NZS 1576.1-2010, 3.12.5)

  Yes

  No

  N/A

Formwork: (Division 7 Occupational Safety & Health Regulations 1996)

• Are designer/engineer drawings available on site? (Occupational Safety & Health Regulations 1996 3.79, 3.80 & 3.81 & AS 3610-1995, 2.3)

  Yes

  No

  N/A

• Has an engineer inspected and signed off on any modifications? (AS 3610-1995, 4.2)

  Yes

  No

  N/A

• Is appropriate signage erected to restrict unauthorised entry? (AS 3610-1995, 5.3.3.2)

  Yes

  No

  N/A

• Are installers properly trained to erect formwork using safe methods? (AS 3610-1995, 5.3.3.1)

  Yes

  No

  N/A

• Are braces installed to prevent movement as per manufacturers specifications? (AS 3610-1995, 5.3.4)

  Yes

  No

  N/A

• Are bearers and joists in good condition? (AS 3610-1995, 5.3.5)

  Yes

  No

  N/A

• Is plywood in good condition and labelled with the manufacturers name, the AS, surface quality, grade, bond, and stress grade? (AS 6669-2007, 1.11)

  Yes

  No

  N/A

• Is edge protection installed as soon as possible?

  Yes

  No

  N/A

• Are designated access ways defined?

  Yes

  No

  N/A

• Are work platforms at least 450mm wide?

  Yes

  No

  N/A

• Are penetrations covered immediately, secured and marked? (Section 3.54 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Is access restricted during erection, pours and stripping?

  Yes

  No

  N/A

• Has an engineer signed off before stripping commences? (AS 3610-1995, 2.3)

  Yes

  No

  N/A

Jump Forms

• Is there at least two forms of access and egress to the jump form?

  Yes

  No

  N/A

• Ladders are only used as a secondary means of access and egress or where no other means are practicable?

  Yes

  No

  N/A

• Is there safe access and egress in the event of an emergency including retrieval of injured persons?)

  Yes

  No

  N/A

• Is there adequate lighting (40 lux) for access and egress for the jump form?

  Yes

  No

  N/A

• Is there emergency backup lighting at a level of 20 lux for at least one hour? (AS 3012-2010, 2.7.3)

  Yes

  No

  N/A

• Have emergency procedures including retrieval of injured persons been tested?

  Yes

  No

  N/A

• Have workers been trained in implementing emergency procedures in the event emergency services are unavailable?

  Yes

  No

  N/A

• Does the jump form have adequate fire fighting equipment?

  Yes

  No

  N/A

• Is access to first aid readily available?

  Yes

  No

  N/A

• Are procedures in place to cease jump form work in the event of inclement weather? (AS/NZS :2550)

  Yes

  No

  N/A

• Is there adequate lighting (160 lux) to carry out work in the jump form?

  Yes

  No

  N/A

• Is there sufficient ventilation enabling workers to carry out work safely?

  Yes

  No

  N/A

• Do workers have access to cool, clean drinking water?

  Yes

  No

  N/A

• Do workers have reasonable access to toilets?

  Yes

  No

  N/A

Plant ( Part 4 : Divisions 1-4 Occupational Safety & Health Regulations 1996 )

• Is there a plant register kept on site?

  Yes

  No

  N/A

• Is a copy of the manufacturers specifications available?

  Yes

  No

  N/A

• Does the plant comply with manufacturers recommendations?

  Yes

  No

  N/A

• Is the design registration readily accessible? (Section 3.40 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• Plant is only used for the purpose which it is designed?

  Yes

  No

  N/A

• Does the operator/installer have appropriate license/competency?

  Yes

  No

  N/A

• Are log books kept and up to date? (As per manufacturers recommendations )

  Yes

  No

  N/A

• Has a Safe Work Method Statement (SWMS) been prepared for the work?

  Yes

  No

  N/A

• Is the SWMS being followed?

  Yes

  No

  N/A

• Are all controls and instruments clearly labelled, marked and operating correctly - including lights, horn, emergency cutoff, brakes, gauges etc.?

  Yes

  No

  N/A

• Is there a fire extinguisher fitted?

  Yes

  No

  N/A

• Has routine maintenance been performed?

  Yes

  No

  N/A

• Have the major inspections been completed as per the manufacturer's specifications?

  Yes

  No

  N/A

• There are no obvious signs of oil/fluid leaks?

  Yes

  No

  N/A

• Are reverse alarm and warning devices fitted?

  Yes

  No

  N/A

• Is a seat belt fitted and in use?

  Yes

  No

  N/A

• Are controls in place to separate pedestrians from moving plant and machinery?

  Yes

  No

  N/A

Power/Hand Tools

• Are tools being used for their intended purpose?

  Yes

  No

  N/A

• Is adequate storage provided?

  Yes

  No

  N/A

• Are tools in good working condition?

  Yes

  No

  N/A

• Have workers been trained in the correct use of tools? (Section 19 Occupational Safety & Health Act 1984)

  Yes

  No

  N/A

• Are any guards and safety devices fitted and not altered?

  Yes

  No

  N/A

Specific Plant Assessments

• Concrete pumps and placement booms

• Is there an instruction manual kept with the pump unit which includes; set up procedures, operating instructions, clean out procedures, and maintenance procedures?

  Yes

  No

  N/A

• Is there a logbook kept on the pump and available for inspection?

  Yes

  No

  N/A

• Is the logbook maintained and kept up to date?

  Yes

  No

  N/A

• Does the logbook show daily pre-operation inspections?

  Yes

  No

  N/A

• Does the logbook show routine maintenance inspections?

  Yes

  No

  N/A

• Does the logbook show annual inspections?

  Yes

  No

  N/A

• Is the assessment for service (six year major) current?

  Yes

  No

  N/A

• Has pipeline thickness testing been performed regularly (for single wall)?

  Yes

  No

  N/A

• Is there a procedure for pipe discard (twin wall)?

  Yes

  No

  N/A

• Has the operator received appropriate training, information and instruction for this particular pump?

  Yes

  No

  N/A

• Has the line hand received the same inductions?

  Yes

  No

  N/A

• Are there documented records of worker training and inductions?

  Yes

  No

  N/A

• Are there any outstanding enforcement notices on the concrete pump?

  Yes

  No

  N/A

• For mobile boom pumps, is there a current plant registration? (Section 4.1 Occupational Safety & Health Regulations 1996 )

  Yes

  No

  N/A

• For mobile boom pumps, does the operator hold the relevant High Risk Work Licence (HRWL)?

  Yes

  No

  N/A

• Does the truck have the appropriate fixed compliance plant and/or certification for its use?

  Yes

  No

  N/A

• Is the operator aware of appropriate exclusion zones for electrical conductors?

  Yes

  No

  N/A

• Are warning and operational signs fitted?

  Yes

  No

  N/A

• Is there a warning device fitted that can be operated from the ground near the hopper area?

  Yes

  No

  N/A

• Are there easily accessible emergency stops fitted?

  Yes

  No

  N/A

• Is there easy, safe access onto the pump?

  Yes

  No

  N/A

• Are there any uncontrolled slip, trip, or protrusion hazards?

  Yes

  No

  N/A

• Do the air reservoir tanks have a pressure gauge fitted?

  Yes

  No

  N/A

• Is there a blow off or safety valve fitted on the tanks?

  Yes

  No

  N/A

• Is there an indication that the module mounting bolts are loose or missing?

  Yes

  No

  N/A

• Are there any visible cracks in the chassis or module?

  Yes

  No

  N/A

• Are all the controls for the boom and outrigger operation clearly marked and visible?

  Yes

  No

  N/A

• Are all pressure gauges and controls clearly marked and functional on the control panel?

  Yes

  No

  N/A

• Is there a safety chain, sling or other retaining device fitted to the drop hose and reducer?

  Yes

  No

  N/A

• Does the drop hose comply with the manufacturers specifications?

  Yes

  No

  N/A

• Are all retaining clamps fitted to quick release pipe clamps?

  Yes

  No

  N/A

• Do the clamps appear to be in good condition?

  Yes

  No

  N/A

• Are the clamps marked with their maximum operating pressure?

  Yes

  No

  N/A

• Are high pressure clamps used at the hopper end?

  Yes

  No

  N/A

• Does the pipeline appear to be in good condition?

  Yes

  No

  N/A

• Are there any visible cracks in the boom?

  Yes

  No

  N/A

• Are there any signs that any boom pins are worn or are there missing retainers or keepers?

  Yes

  No

  N/A

• Are there any visible oil leaks?

  Yes

  No

  N/A

• Are there any damaged hydraulic hoses?

  Yes

  No

  N/A

• Are there any exposed moving parts (eg. fans, shafts, pulleys or unguarded gears)?

  Yes

  No

  N/A

• Are the stabiliser legs/outriggers in good condition?

  Yes

  No

  N/A

• Are pads/timbers provider under outrigger feet?

  Yes

  No

  N/A

• Can the outriggers be securely locked in place when the pump is in travel mode?

  Yes

  No

  N/A

• If short legging is used, does the manufacturer allow it and are there written procedures?

  Yes

  No

  N/A

• If there is a risk of collision with the boom is there a procedure to help prevent this?

  Yes

  No

  N/A

• Is a hopper grill in place that provides adequate protection from moving parts?

  Yes

  No

  N/A

• Do the agitator paddles and valve system stop when the grill is lifted?

  Yes

  No

  N/A

• Does the accumulator drop all pressure when the grill is lifted?

  Yes

  No

  N/A

• If compressed air is used for cleaning out the lines, is there a system to indicate when the line is pressurised?

  Yes

  No

  N/A

• Is the dump valve on the blow out head twice the size as the inlet valve?

  Yes

  No

  N/A

• Are controls in place to prevent the sponge ball from becoming a dangerous projectile?

  Yes

  No

  N/A

• Is suitable Personal Protective Equipment (PPE) worn by the operator and the line hand?

  Yes

  No

  N/A

• Is a sufficient and hygienic First Aid kit provided?

  Yes

  No

  N/A

• Is traffic management being conducted in a safe manner?

  Yes

  No

  N/A

• To reduce the risk of hose whip, is there a safety observer in place during pump operation to monitor the level of concrete in the hopper to ensure air is not sucked into the pump system?

  Yes

  No

  N/A

• If the boom is a 32m Daewoo or Everdigm boom, has the issue of boom collapse near the wear plates been addressed?

  Yes

  No

  N/A

• Piling Rigs

• Are Compliance/ID Plates fitted to the machine?

  Yes

  No

  N/A

• Are load charts fitted inside the cabin?

  Yes

  No

  N/A

• Are the tracks in good condition, with no obvious signs of damage to treads or sprockets?

  Yes

  No

  N/A

• Is cabin kept neat and tidy to allow safe operation?

  Yes

  No

  N/A

• Are all chains fitted with tags identifying Safe Working Loads (SWL's), serial numbers and test dates?

  Yes

  No

  N/A

• Does all other lifting equipment have SWL's, serial numbers and test dates clearly marked?

  Yes

  No

  N/A

• Is there means for effective communication in place between the operator, offsiders, supervisors and others?

  Yes

  No

  N/A

• Is there an effective operational safety zone (OSZ) set up?

  Yes

  No

  N/A

• The equipment is not operating within the "no go zone" near overhead powerlines?

  Yes

  No

  N/A

• Are exclusion zones set up within the OSZ to prevent access to high risk areas?

  Yes

  No

  N/A

• Has a competent person (e.g. Geotechnical Engineer) inspected and signed off prior to works commencing?

  Yes

  No

  N/A

• Hoists

• Has the hoist been installed as per engineers recommendations?

  Yes

  No

  N/A

• Is the mast plumb with no obvious damage to the mast or rollers?

  Yes

  No

  N/A

• Are the mast ties installed at intervals specified in the operations manual or engineering drawings?

  Yes

  No

  N/A

• Is the hoist power supplied directly from the main switchboard not a sub board? (AS/NZS 3012-2010, Appendix J)

  Yes

  No

  N/A

• Is electrical equipment/cables contained and protected against mechanical damage? (AS/NZS3012-2010)

  Yes

  No

  N/A

• Does the hoist encroach on any "no go zones" for overhead powerlines?

  Yes

  No

  N/A

• Has the operator been trained specifically for the model in operation?

  Yes

  No

  N/A

• Can the operator describe the method required for resetting the overspeed device? (AS 2550.7, 7.2.1)

  Yes

  No

  N/A

• Can the operator describe the procedure for lowering the car in the event of an emergency?

  Yes

  No

  N/A

• Are the make, model, serial number and Safe Working Load (SWL) prominently displayed inside the car? (AS1418.7, 4.7)

  Yes

  No

  N/A

• Does the overspeed safety device have a metal plate fitted that is readily visible and marked with the maximum speed in m/sec, the manufacturer and serial number, and the retest date of the gear? (AS1418.7, 4.5.7.4)

  Yes

  No

  N/A

• Has the daily pre-operational inspection been completed? (AS2550.7, 7.2.2 & 9.2)<br><br>Checks should include;<br>- operating and emergency controls<br>- safety switches and interlocks<br>- structure<br>- cables and wiring<br>- placards, decals, warnings, control markings, operating manuals and logbooks<br>- access provisions<br>- guarding<br>- cleanliness, including build-up of building materials or waste under the platform<br>- freedom of movement of the hoist, including ensuring that there are no external obstructions in the hoists path<br>- items specified by the management

  Yes

  No

  N/A

• Are all safety related problems rectified prior to using the hoist?

  Yes

  No

  N/A

• Is the car free from excessive damage?

  Yes

  No

  N/A

• Is the hoist provided with both normal and emergency lighting? ( AS1418.7, 4.6.2.4)

  Yes

  No

  N/A

• Are the operator controls inside the car, functioning as intended, in good condition, and clearly marked?

  Yes

  No

  N/A

• Are the emergency stops clearly marked and functioning as intended? (AS1418.7, 4.5.9)

  Yes

  No

  N/A

• Are the final limit switches functioning correctly? (AS1418.7, 4.5.14)

  Yes

  No

  N/A

• Is there adequate access to the roof of the car?

  Yes

  No

  N/A

• Is there adequate compliant handrail on the roof? (AS/NZS :1657)

  Yes

  No

  N/A

• Is the floor of the car and all landings free of materials and debris?

  Yes

  No

  N/A

• is the risk of falling objects adequately controlled at each landing?

  Yes

  No

  N/A

• Is the risk of falls adequately controlled at each landing?

  Yes

  No

  N/A

All Cranes: (Division 4 Occupational Safety and Health Regulations 1996 Section 4.54)

• Is the crane registered?

  Yes

  No

  N/A

• Are all records kept on site? AS/NZS 2550.1, 6.2)

  Yes

  No

  N/A

• Are regular maintenance checks done by a competent person? (AS 2550.1, 6.2)

  Yes

  No

  N/A

• Does the crane comply with manufacturers specifications and have no modifications or alterations? (AS 2550.1, 6.3)

  Yes

  No

  N/A

• Have daily pre-start checks been completed? (AS 2550.1, 6.1)

  Yes

  No

  N/A

• Are log books completed and up to date? (AS 2550.1, 7.3)

  Yes

  No

  N/A

• Are clearance zones established around the cranes? (AS 2550.1, 4.3)

  Yes

  No

  N/A

• Are no go zones setup for not coming within 6m of powerlines or 3m with a qualified spotter? (c166 & AS 2550.1, 6.19)

  Yes

  No

  N/A

• Are safe systems and procedures in place to avoid collisions with other cranes, people or plant? (AS 2550.1-4.5)

  Yes

  No

  N/A

• Are drivers and dogmen appropriately licensed? (AS 2550.1-6.2)

  Yes

  No

  N/A

• Are there enough doggers to handle the workload?

  Yes

  No

  N/A

• Are wind/weather conditions monitored? (AS 2550.1-6.22)

  Yes

  No

  N/A

• Are emergency procedures in place? (AS 2550.1-6.2)

  Yes

  No

  N/A

Mobile Cranes

• Does the crane have the CraneSafe green sticker displayed?

  Yes

  No

  N/A

• Is the crane setup on firm, level ground rated to take it's load?

  Yes

  No

  N/A

• Is the crane fitted with outriggers?

  Yes

  No

  N/A

• Are they;

• Set correctly according to the manufacturers recommendations?

  Yes

  No

  N/A

• On pads fully supported by ground?

  Yes

  No

  N/A

• Set to lift all wheels off the ground?

  Yes

  No

  N/A

• Is the proper counter weight being used?

  Yes

  No

  N/A

• Are tag lines used for pick and carry operations?

  Yes

  No

  N/A

Vehicle Loading Cranes

• Is the operator competent?

  Yes

  No

  N/A

• Are stabilisers extended?

  Yes

  No

  N/A

• Are wheels still on the ground?

  Yes

  No

  N/A

• Is tyre pressure correct, as per manufacturers specifications?

  Yes

  No

  N/A

Tower Cranes

• Have pre-erection inspections been completed?

  Yes

  No

  N/A

• Have pre-commissioning inspections been completed?

  Yes

  No

  N/A

• Does crane have CraneSafe green sticker displayed?

  Yes

  No

  N/A

• Is base fully enclosed with 1.8m fencing?

  Yes

  No

  N/A

• Do operators have safe access and egress? (AS 2550.1-6.2)

  Yes

  No

  N/A

• Is the crane remotely operated?

  Yes

  No

  N/A

• Are the following measures in place; (AS 2550.1-6.3)

• Operator works from a designated area which is close to the crane and can maintain good visibility of the load?

  Yes

  No

  N/A

• Operator remains stationary when the load is in motion?

  Yes

  No

  N/A

• Have doggers to direct the operator whenever the load is out of sight?

  Yes

  No

  N/A

• The remote control is protected from unauthorised use?

  Yes

  No

  N/A

Lifting Equipment

• Is there a register of all lifting equipment?

  Yes

  No

  N/A

• Is the working load limit (WLL) clearly displayed?

  Yes

  No

  N/A

• Is an identification number displayed?

  Yes

  No

  N/A

• Do hooks have operable safety latches fitted?

  Yes

  No

  N/A

• Is the correct lifting equipment being used for the load?

  Yes

  No

  N/A

• Are loads slung correctly and safely?

  Yes

  No

  N/A

• Is equipment stored correctly?

  Yes

  No

  N/A

• Is equipment in good condition and inspected regularly?

  Yes

  No

  N/A

• Are soft slings being used?

  Yes

  No

  N/A

• Are they;

• Inspected before each use and at least once every three months?

  Yes

  No

  N/A

• Proof load tested every twelve months?

  Yes

  No

  N/A

• Free of external wear, cuts and abrasions?

  Yes

  No

  N/A

• Not discoloured from sunlight, high temperatures or chemical exposure?

  Yes

  No

  N/A

• Fitted with undamaged clear labels or tags?

  Yes

  No

  N/A

• Stored in a clean, dry and ventilated place?

  Yes

  No

  N/A

• Slings are not stored on the ground?

  Yes

  No

  N/A

• No slings in use have knots tied in them or are twisted?

  Yes

  No

  N/A

• Is protection in place on sharp edges?

  Yes

  No

  N/A

• Are there documented lifting procedures in place for special lifts? (AS 2550.1)

  Yes

  No

  N/A

Man Boxes (AS 2550.1-6.18)

• Is the man box registered?

  Yes

  No

  N/A

• Are emergency retrieval plans in place before any workers are lifted?

  Yes

  No

  N/A

• Is the box marked with the safe working load, tare mass and design registration number?

  Yes

  No

  N/A

• Are fall-arrest anchorage points installed?

  Yes

  No

  N/A

• Is the box supplied with lifting slings attached by hammerlocks or moused shackles?

  Yes

  No

  N/A

• Does the work box have an inward opening, self-closing door with a latch to prevent unintentional opening?

  Yes

  No

  N/A

• Is there a first aid cage on site?

  Yes

  No

  N/A

• Does the cage;

• Only get used to retrieve injured people?

  Yes

  No

  N/A

• Sit within the radius of the crane and is easily accessible?

  Yes

  No

  N/A

• Have clear first aid signage?

  Yes

  No

  N/A

• Have an outward swinging door to allow stretcher access?

  Yes

  No

  N/A

• Have fully enclosed sides to prevent falls?

  Yes

  No

  N/A

Hazardous Chemicals: (Part 5 Occupational Health & Safety Regulations 1996 )

• Are hazardous materials correctly labelled? (Part 5 Occupational Health & Safety Regulations 1996 )

  Yes

  No

  N/A

• Are current safety data sheets on site and easily accessible? (Section 5.5 Occupational Health & Safety Regulations 1996 )

  Yes

  No

  N/A

• Is there a hazardous chemicals register kept on site and up to date?

  Yes

  No

  N/A

• Is there signage to warn of hazardous chemical risks?

  Yes

  No

  N/A

• Are there measures in place to contain and manage spills?

  Yes

  No

  N/A

• Is there appropriate fire protection/firefighting equipment for the types of hazardous chemicals on site?

  Yes

  No

  N/A

• Is correct safety equipment/PPE provided, maintained and accessible?

  Yes

  No

  N/A

• Are workers trained and supervised in the correct handling of hazardous chemicals? (Section 19 Occupational Health & Safety Act 1984

  Yes

  No

  N/A

Asbestos (Division 4 Occupational Health & Safety Regulations 1996 ) (Code of Practice safe removal of asbestos 2nd edition)

• Have workers been trained in asbestos awareness?

  Yes

  No

  N/A

• Has asbestos been discovered at the workplace?

  Yes

  No

  N/A

• Have WorkCover been notified of removal?

  Yes

  No

  N/A

• Has an occupational hygienist been engaged?

  Yes

  No

  N/A

• Has a licensed removalist been contracted to remove asbestos?

  Yes

  No

  N/A

• Have workers been trained?

  Yes

  No

  N/A

• Is there an asbestos management plan in place?

  Yes

  No

  N/A

• Does the plan include;

• Processes for reviewing and keeping the plan up to date?

  Yes

  No

  N/A

• The identification of asbestos or ACM?

  Yes

  No

  N/A

• Reasons for decisions, about the management of asbestos?

  Yes

  No

  N/A

• Procedures for dealing with asbestos emergencies?

  Yes

  No

  N/A

• Information for workers responsibilities, consultation, information and training?

  Yes

  No

  N/A

• Has an asbestos register been prepared for the workplace?

  Yes

  No

  N/A

• Does the register include;

• Regular reviews and updating?

  Yes

  No

  N/A

• Identification of asbestos or ACM presence?

  Yes

  No

  N/A

• The date on which it was identified?

  Yes

  No

  N/A

• The location, type and condition of the asbestos or ACM?

  Yes

  No

  N/A

• Has an asbestos removal control plan been prepared?

  Yes

  No

  N/A

• Does the plan include;

• Details of how the work will be carried out including method, tools, equipment and PPE?

  Yes

  No

  N/A

• Details of the asbestos to be removed including location, type and condition?

  Yes

  No

  N/A

• Has a copy has been provided to the principal contractor?

  Yes

  No

  N/A

• Has the site been cleared by occupational hygienists?

  Yes

  No

  N/A

• Is there a clearance certificate on site?

  Yes

  No

  N/A

Confined Spaces

• Is work being carried out in confined spaces?<br><br>WHS Regulations 2011 section 5 <br>CONFINED SPACE MEANS an enclosed or partially enclosed space that:<br>(a) is not designed or intended primarily to be occupied by a person, and<br>(b) is, or is designed or intended to be, at normal atmospheric pressure while any person is in the space, and<br>(c) is or is likely to be a risk to health and safety from:<br>(i) an atmosphere that does not have a safe oxygen level, or<br>(ii) contaminants, including airborne gases, vapours and dusts, that may cause injury from fire or explosion, or<br>(iii) harmful concentrations of any airborne contaminants, or<br>(iv) engulfment,<br>

  Yes

  No

  N/A

• Has a risk assessment been done by a competent person? (c66)

  Yes

  No

  N/A

• Have signs been erected before and for the duration of works? (c68)

  Yes

  No

  N/A

• Confined space entry permits have been issued? (c67)

  Yes

  No

  N/A

• Does it;

• Identify the confined space to be entered?

  Yes

  No

  N/A

• Contain the names of the people entering?

  Yes

  No

  N/A

• Contain the duration of the work to be done?

  Yes

  No

  N/A

• Show measures that are in place based on the risk assessment?

  Yes

  No

  N/A

• Emergency procedures are in place including rescue? (c66)

  Yes

  No

  N/A

• First Aid and rescue procedures have been tested and are effective? (c74)

  Yes

  No

  N/A

• Are flammable gases, vapours or mist monitored? (c72)

  Yes

  No

  N/A

• Is continuous communication with a worker outside the confined space maintained? (c69)

  Yes

  No

  N/A

• Have workers been issued with and trained to use PPE including respiratory equipment? (c75)

  Yes

  No

  N/A

Demolition

• Is there any demolition of a structure or part of a structure that is load-bearing?

  Yes

  No

  N/A

• Has WorkCover been notified? (c142)

  Yes

  No

  N/A

• Does the demolition contractor hold the appropriate license?

  Yes

  No

  N/A

• Have the necessary engineer reports been obtained?

  Yes

  No

  N/A

• Is a Demolition Plan in place?

  Yes

  No

  N/A

• Does the plan include;

• The location of the structure to be demolished?

  Yes

  No

  N/A

• The overall height of the structure and the distance from boundaries?

  Yes

  No

  N/A

• The type of structure, it's supports and materials?

  Yes

  No

  N/A

• The proposed methods of demolition and the types of plant/equipment to be used?

  Yes

  No

  N/A

• The proposed methods for handling and disposing of materials?

  Yes

  No

  N/A

• Proposed methods of controlling access and egress to the workplace?

  Yes

  No

  N/A

• The sequence of works and duration of each?

  Yes

  No

  N/A

• The proposed hoardings, scaffolding and fencing?

  Yes

  No

  N/A

• Traffic management plans?

  Yes

  No

  N/A

• Exclusion zones that are established to protect workers?

  Yes

  No

  N/A

• Essential services have been located and disconnected? (c304)

  Yes

  No

  N/A

• The general condition and effect on neighbouring structures and businesses?

  Yes

  No

  N/A

• Emergency arrangements and rescue plans?

  Yes

  No

  N/A

• Has a copy of the asbestos register been obtained? (c450)

  Yes

  No

  N/A

• Has an occupational hygienist inspected the site? (c451)

  Yes

  No

  N/A

• If asbestos or ACM is present, has it been removed before demolition work commenced? (c451)

  Yes

  No

  N/A

• Has a test been conducted for the presence of lead and other hazardous materials?

  Yes

  No

  N/A

• If there are any present, what are they?

• Are control measures in place for working with hazardous materials?

  Yes

  No

  N/A

• There is no over-lapping of demolition work and construction?

  Yes

  No

  N/A

Excavation

• Are there excavation works taking place?

  Yes

  No

  N/A

• Has current information on underground essential services been obtained? (c304)

  Yes

  No

  N/A

• Does the information contain;

• The services which may be affected?

  Yes

  No

  N/A

• The location, including depth, of any pipes, cables or other plant?

  Yes

  No

  N/A

• Any conditions on the proposed excavation work?

  Yes

  No

  N/A

• Have workers been provided with the information? (c304)

  Yes

  No

  N/A

• Have the ground/soil conditions been assessed by a competent person?

  Yes

  No

  N/A

• Are control measures in place to stop a person from falling into excavations? (c305)

  Yes

  No

  N/A

• Are preventions in place to stop a person working in the excavation from being struck by a falling object? (c55 & c305)

  Yes

  No

  N/A

• Have tests/monitoring taken place to prevent anyone being exposed to airborne contaminates? (c305)

  Yes

  No

  N/A

• Is the excavation secured to prevent unauthorised access? (c306)

  Yes

  No

  N/A

• Have measures been put in place, such as shoring, benching or battering to prevent collapse? (c306)

  Yes

  No

  N/A

Environmental

• Is there an Environmental Management Plan in place? (ISO 14001)

  Yes

  No

  N/A

• Does the plan include;

• Which licenses, consents and approvals are required?

  Yes

  No

  N/A

• How compliance with environmental legislation will be achieved?

  Yes

  No

  N/A

• Instructions on how contractors must meet obligations?

  Yes

  No

  N/A

• Procedures for dealing with environmental emergencies?

  Yes

  No

  N/A

• Procedures for reviewing and updating the plan?

  Yes

  No

  N/A

Water

• Is there a Water Quality Management Plan in place?

  Yes

  No

  N/A

• Does the plan include;

• Use of silt fences and traps?

  Yes

  No

  N/A

• Procedures for de-watering including testing and permits?

  Yes

  No

  N/A

• Paint, truck and concrete washouts?

  Yes

  No

  N/A

• Plans for collecting and discharging storm-water and ground-water?

  Yes

  No

  N/A

• Measures to avoid the release of contaminates into waterways/drainage systems?

  Yes

  No

  N/A

• Are controls in use and maintained?

  Yes

  No

  N/A

Erosion and Sediment

• Is there an Erosion and Sediment Control Plan in place?

  Yes

  No

  N/A

• Does the plan include;

• Use of sediment fences?

  Yes

  No

  N/A

• Measures for controlling stockpiles?

  Yes

  No

  N/A

• Cattle grids and street sweeping to prevent mud and dirt on the roadways?

  Yes

  No

  N/A

• Sediment control barriers/filtration for drains?

  Yes

  No

  N/A

• Stabilisation of soils that will be exposed for more than 28 days?

  Yes

  No

  N/A

• Are controls in use and maintained?

  Yes

  No

  N/A

Dust and Air

• Is there a Dust and Air Quality Protection Plan in place?

  Yes

  No

  N/A

• Does the plan include;

• Controls so that no dust, fumes, odours or chemical emissions are released beyond site boundaries?

  Yes

  No

  N/A

• Dust suppression measures?

  Yes

  No

  N/A

• Procedures to meet DA requirements and monitoring?

  Yes

  No

  N/A

• Speed limits to lower dust generation?

  Yes

  No

  N/A

• Gravel on haul roads and high traffic areas?

  Yes

  No

  N/A

• Mesh on perimeter fences to act as wind protection and prevent dust from leaving?

  Yes

  No

  N/A

• Maintenance of plant and equipment?

  Yes

  No

  N/A

• Monitoring of vehicle emissions?

  Yes

  No

  N/A

• Covering of loads?

  Yes

  No

  N/A

• Are controls in use and maintained?

  Yes

  No

  N/A

Noise and Vibration

• Is there a Noise and Vibration Management Plan in place?

  Yes

  No

  N/A

• Does the plan include;

• Work is conducted within work hours as defined by council?

  Yes

  No

  N/A

• Noise emission from plant is kept low? (WHS Regs 59)

  Yes

  No

  N/A

• Workers are not exposed to excessive noise, above 85dB/8h or above 140dB? (c57)

  Yes

  No

  N/A

• Workers are provided with audiometric testing? (c58)

  Yes

  No

  N/A

• Excessive vibration is monitored?

  Yes

  No

  N/A

• Neighbours are contacted about excessive noise and vibration?

  Yes

  No

  N/A

• Are controls in use and maintained?

  Yes

  No

  N/A

Waste

• Is there a Waste Management Plan in place?

  Yes

  No

  N/A

• Does the plan include;

• Storage areas for separation, collection and recycling?

  Yes

  No

  N/A

• The use of licensed contractors to remove waste?

  Yes

  No

  N/A

• Recycling of materials from the site office?

  Yes

  No

  N/A

• Receipts are kept for disposal of waste?

  Yes

  No

  N/A

• Waste minimisation measures for contractors?

  Yes

  No

  N/A

• Procedures for dealing with contaminated waste?

  Yes

  No

  N/A

• Are controls in use and maintained?

  Yes

  No

  N/A

Sign-off

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  Media

• Notes

• Signed off by

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