CFMEU Construction & General - NSW

• Document No.

• Audit Title

• Employer/Builder

• Employer Representative/ Phone Number/ Position

• Site Address
  Address

• Conducted on

  Date

• Prepared by

Entry Permit

• Notice issued to -

• Date of entry -

  Date

• Name of person conducting a business or undertaking -

• Site address -
  Address

• Name of entry permit holder representing the Construction Forestry Mining Energy Union, giving notice pursuant to s119 of the Work Health and Safety Act 2011, reasonably suspecting that you are in contravention of the Work Health and Safety Act 2011 - s19 and the Work Health and Safety Regulation 2011 - c35, in circumstances that make it likely that the contravention will continue or be repeated.

• Entry under (tap to select) -

  Select Section 117 Section 120 Section 121

  • Section 117
  • Section 120
  • Section 121

• Was entry refused or delayed? (s144)

  Yes

  No

  N/A

• Have you been hindered or obstructed while exercising any rights? (s145)

  Yes

  No

  N/A

• Has any person made misrepresentations about Part 7 of the WHS Act 2011? (s147)

  Yes

  No

  N/A

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

• Your attention is drawn to (legislation, Australian Standard, COP, guideline, etc where relevant) -

• I declare:
  
  a) that the union is entitled to represent the industrial interests of a worker who carries out work at the workplace entered and is a member, or eligible to be a member, of the union pursuant to the Rules of the Construction Forestry Mining and Energy Union, under Rule 2,
  b) and is entitled to represent the industrial interests of that worker; and,
  c) that the suspected contravention relates to, or affects, that worker.
  
  Note - S130 of the WHS Act 2011 provides that a WHS Entry Permit Holder is not required to disclose the name of any worker to the person conducting a business or undertaking, and may do so only with the consent of the worker.

• Signed -

  Sign

Incident Report

• Date/Time of Incident -

  Date

• Principal Contractor -

• Sub-Contractor -

• Health and Safety Representative -

• Incident Type (tap to select) -

  Fatality

  Injury

  Near Miss

• Primary 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

• 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? (s35)

  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? (clause 308 WHS Regulation 2011)

  Yes

  No

  N/A

• Does it display;

• The principal contractor's name and telephone contact number, Including after hours? (c308-a)

  Yes

  No

  N/A

• The location of the site office? (c308-b)

  Yes

  No

  N/A

• PPE requirements for the site?

  Yes

  No

  N/A

• The presence of hazardous chemicals? (c349)

  Yes

  No

  N/A

• Is the site secured to prevent unauthorised access? (c298-1)

  Yes

  No

  N/A

• Are hazards isolated in the event of unauthorised entry occurring? (c298-2,c)

  Yes

  No

  N/A

• Have workers been site inducted? (c39)

  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? (c316)

  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 WHS Management Plan been prepared for the workplace before commencement? (c309)

  Yes

  No

  N/A

• Does the plan include;

• Names, positions and responsibilities of all persons with WHS duties at the workplace? (c309-2,a)

  Yes

  No

  N/A

• Arrangements for consultation, co-operation and co-ordination at the workplace? (c309-2,b)

  Yes

  No

  N/A

• Arrangements for managing any work health and safety incidents that occur? (c309-2,c)

  Yes

  No

  N/A

• Site-specific safety rules, and arrangements for ensuring all persons are informed? (c309-2,d)

  Yes

  No

  N/A

• Arrangements for collecting, assessing and reviewing SWMS? (c309-2,e)

  Yes

  No

  N/A

• Are safe work method statements prepared for high risk construction work? (c299)<br><br>(291) 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? (c299-3,b)

  Yes

  No

  N/A

• Are arrangements in place to ensure SWMS are complied with? (c300-1)

  Yes

  No

  N/A

• Is high risk construction work performed in accordance with SWMS? (c300-2)

  Yes

  No

  N/A

• Has work been stopped immediately and resumed only in accordance with the SWMS? (c300-2)

  Yes

  No

  N/A

Consultation

• Are there methods for consultation in place? (c309-2,b)

  Yes

  No

  N/A

• Are workers being consulted about ALL matters affecting their health & safety? (section 47 WHS Act 2011)

  Yes

  No

  N/A

• Is there an up to date list of HSR's displayed? (s74)

  Yes

  No

  N/A

• Have HSR's requested and completed training within 3 months of making request? (s72)

  Yes

  No

  N/A

• Is there a site safety committee? (s75)

  Yes

  No

  N/A

• Has a constitution been prepared and agreed by workers and the PCBU? (s76-1)

  Yes

  No

  N/A

• Is at least half of the committee made up of workers not nominated by the PCBU? (s76-4)

  Yes

  No

  N/A

• Are names displayed in a prominent place? (s74)

  Yes

  No

  N/A

• Are minutes from safety committee meetings posted at the workplace? (s77)

  Yes

  No

  N/A

• Are HSR's and/or safety committee being notified and included in incident investigations? (s70)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are regular safety walks being conducted? (s68)

  Yes

  No

  N/A

• Are any Improvement Notices issued by HSR's displayed in a prominent place? (s97)

  Yes

  No

  N/A

• Has the Improvement Notice been complied with in the specified time? (s99)

  Yes

  No

  N/A

Amenities

• Are there adequate amenities for all workers on site? (c41-3)

  Yes

  No

  N/A

• Are amenities hygienic, ventilated and well lit? (c41-2)

  Yes

  No

  N/A

• Are there covered walkways to access amenities in the event of inclement weather? (c40-a)

  Yes

  No

  N/A

• Is there 1m2 available to seat each worker at one time? (c41-1)

  Yes

  No

  N/A

• Are there enough toilets to suit 1 per 15 males? (c41-1)

  Yes

  No

  N/A

• Are there enough urinals to suit 1 per 20 males, or 600mm of trough each? (c41-1)

  Yes

  No

  N/A

• Are there enough toilets to suit 1 per 10 females? (c41-1)

  Yes

  No

  N/A

• On multi-storey buildings are toilets located on at least every third floor? (c41-2)

  Yes

  No

  N/A

• Are toilets clean, hygienic, well lit and easily accessible? (c41-2)

  Yes

  No

  N/A

• Are there enough hand-washing basins provided to suit 1 per 30 workers? (c41-1)

  Yes

  No

  N/A

• Do workers have easy access to cool, clean drinking water? (c41-1)

  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 a clear space of 0.5m per worker?

  Yes

  No

  N/A

• Is there enough seating for workers to get changed?

  Yes

  No

  N/A

• Are there mirrors either inside or directly outside?

  Yes

  No

  N/A

• Is there an adequate number of hooks and/or shelves?

  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

• Are partitions at least 1650mm high and no higher than 300mm above the floor?

  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? (c42)

  Yes

  No

  N/A

• Are first aid locations clearly signed and marked? (c42)

  Yes

  No

  N/A

• Are there enough trained first aiders, 1 per 25 workers, or 1 per 10 for remote workplaces? (c42)

  Yes

  No

  N/A

• Do workers have an effective means of communicating with first aiders such as 'nurse calls'? (c42-3)

  Yes

  No

  N/A

• Is there a first aid room? (c42-1)

  Yes

  No

  N/A

• Is the room hygienic, ventilated and well lit? (c41-2)

  Yes

  No

  N/A

• Is it easily accessible, with a minimum door width of 1m? (c41-2)

  Yes

  No

  N/A

• Is there adequate first aid equipment? (c42-1)

  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? (c42-1)

  Yes

  No

  N/A

• Are first aid records kept on site? (s38-7)

  Yes

  No

  N/A

• Are first aiders and witnesses to serious incidents provided with counselling services? (s19)

  Yes

  No

  N/A

Emergency Plan

• Has an Emergency Plan been prepared and implemented at the workplace? (c43)

  Yes

  No

  N/A

• Have the workers been consulted on the preparation of the Emergency Plan? (s49)<br>

  Yes

  No

  N/A

• An effective response to an emergency? (c43-1,a,i)

  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? (c43-1,a,ii)

  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? (c43-1,a,iii)

  Yes

  No

  N/A

• Provisions for medical treatment and assistance? (c43-1,a,iv)

  Yes

  No

  N/A

• Effective communication between the PCBU and all persons at the workplace? (c43-1,a,v)

  Yes

  No

  N/A

• Frequency for testing of emergency procedures? (c43-1,b)

  Yes

  No

  N/A

• Information, training and instruction for ALL workers in relation to implementing emergency procedures? (c43-1,c)

  Yes

  No

  N/A

• Has the emergency plan been maintained to ensure it remains effective? (c43-2)

  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

• Details of the works to be undertaken, impacts on the surrounding traffic and how those impacts will be addressed? (c315-c)

  Yes

  No

  N/A

• Separation for pedestrians and moving vehicles? (c215-4)

  Yes

  No

  N/A

• A Vehicle Movement Plan for movement within the site?

  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? (c206-3)

  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

• A Traffic Control Plan, where public and pedestrian traffic is affected? (c315-c)

  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? (c315-c)

  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

Site Security

• Is the site fully fenced to restrict unauthorised access? (c298, 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

• Is access blocked underneath the fence? (c298)

  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? (c44-2)

  Yes

  No

  N/A

• Have other control measures been implemented to reduce the amount of PPE needed? (c36)

  Yes

  No

  N/A

• Have workers been consulted about the need for and type of PPE supplied? (s49)

  Yes

  No

  N/A

• Have workers been trained in the use and maintenance of the PPE? (c44-4)

  Yes

  No

  N/A

• Is the PPE suitable for the work, size, fit and comfort of the worker? (c44-3)

  Yes

  No

  N/A

• Is storage provided for PPE? (c44-4)

  Yes

  No

  N/A

• Is the PPE maintained, repaired and replaced as needed? (c44-3)

  Yes

  No

  N/A

Work Areas

• Is there safe access and egress to and from work areas, both under normal conditions and an emergency? (c40-a)

  Yes

  No

  N/A

• Are there walkways to separate workers from moving plant? (c215-4)

  Yes

  No

  N/A

• Are access routes free of obstructions and stored materials? (c40-a)

  Yes

  No

  N/A

• Is access to and from work areas adequately lit to a minimum of 40lux? (c40-d,ii & 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? (c40-b)

  Yes

  No

  N/A

• Are the location of exits clearly marked and are there signs showing directions to exits posted? (c40-a)

  Yes

  No

  N/A

Hazardous Work

• Has a risk assessment been performed for hazardous manual tasks? (c60-1)

  Yes

  No

  N/A

• Have postures, movements, forces and vibration in relation to the task been assessed? (c60-2,a)

  Yes

  No

  N/A

• Has the duration and frequency of the task been assessed? (c60-2,b)

  Yes

  No

  N/A

• Have any environmental concerns affecting the task or the worker been assessed? (c60-2,c)

  Yes

  No

  N/A

• Has the design of the work area been assessed? (c60-2d)

  Yes

  No

  N/A

• Has the layout of the workplace been assessed? (c60-2,e)

  Yes

  No

  N/A

• Have the systems of work been assessed? (c60-2,f)

  Yes

  No

  N/A

• Has the nature, size, weight and/or number of persons involved been taken into account? (c60-2,g)

  Yes

  No

  N/A

• Have workers been trained in correct manual handling techniques? (c39-2)

  Yes

  No

  N/A

• Are workers exposed to excessive levels of noise, either 8 hours above 85dB or 140dB peak? (c56-1)

  Yes

  No

  N/A

• Is exposure to noise being managed in accordance with the hierarchy of control? (c57-1)

  Yes

  No

  N/A

Electrical

• Is electrical equipment regularly tested and tagged? (c150, 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? (c149)

  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

• Has a SWMS has been prepared where a worker can fall 2m or more? (c299)

  Yes

  No

  N/A

• Has a risk assessment been performed for all other heights? (c78)

  Yes

  No

  N/A

• Is the highest measure in the hierarchy of control being implemented? (c79)

  Yes

  No

  N/A

• Are control measures inspected and maintained? (c37)

  Yes

  No

  N/A

• Is edge protection securely fixed and installed as per the manufacturers specifications? (c79)

  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? (c80-2)

  Yes

  No

  N/A

• Have all relevant workers been trained in the emergency procedures? (c80-4)

  Yes

  No

  N/A

• Have the emergency procedures been tested so that they are effective? (c80-3)

  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? (c79)

  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? (c55)

  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 or light duty work of short duration?

  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

• Has written confirmation been received from a competent person stating that scaffolding over 4m is complete? (c225)

  Yes

  No

  N/A

• Has scaffold been inspected and signed off monthly, or following an incident or any alterations? (c225)

  Yes

  No

  N/A

• Is sign-off tag displayed in a conspicuous location?

  Yes

  No

  N/A

• Are incomplete scaffolds appropriately closed and signage installed to prevent unauthorised access? (c225-5)

  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? (c55)

  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

• Are designer/engineer drawings available on site? (c202 & AS 3610-1995, 2.3)

  Yes

  No

  N/A

• Has an engineer inspected and signed off on any modifications? (c295 & 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? (c78)

  Yes

  No

  N/A

• Are designated access ways defined? (c40)

  Yes

  No

  N/A

• Are work platforms at least 450mm wide? (c79)

  Yes

  No

  N/A

• Are penetrations covered immediately, secured and marked? (c78)

  Yes

  No

  N/A

• Is access restricted during erection, pours and stripping? (c55)

  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? (c40)

  Yes

  No

  N/A

• Ladders are only used as a secondary means of access and egress or where no other means are practicable? (c40)

  Yes

  No

  N/A

• Is there safe access and egress in the event of an emergency including retrieval of injured persons? (c43)

  Yes

  No

  N/A

• Is there adequate lighting (40 lux) for access and egress for the jump form? (c40)

  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

• Have emergency procedures including retrieval of injured persons been tested? (c43)

  Yes

  No

  N/A

• Have workers been trained in implementing emergency procedures in the event emergency services are unavailable? (c43)

  Yes

  No

  N/A

• Does the jump form have adequate fire fighting equipment? (c43)

  Yes

  No

  N/A

• Is access to first aid readily available? (c42)

  Yes

  No

  N/A

• Are procedures in place to cease jump form work in the event of inclement weather? (c40, 43 & AS2550)

  Yes

  No

  N/A

• Is there adequate lighting (160 lux) to carry out work in the jump form? (c40)

  Yes

  No

  N/A

• Is there sufficient ventilation enabling workers to carry out work safely? (c40-f)

  Yes

  No

  N/A

• Do workers have access to cool, clean drinking water? (c41)

  Yes

  No

  N/A

• Do workers have reasonable access to toilets? (c41)

  Yes

  No

  N/A

Plant

• Is there a plant register kept on site? (c237)

  Yes

  No

  N/A

• Is a copy of the manufacturers specifications available? (c198)

  Yes

  No

  N/A

• Does the plant comply with manufacturers recommendations? (c202)

  Yes

  No

  N/A

• Is the design registration readily accessible? (c260)

  Yes

  No

  N/A

• Plant is only used for the purpose which it is designed? (c206)

  Yes

  No

  N/A

• Does the operator/installer have appropriate license/competency? (c81)

  Yes

  No

  N/A

• Are log books kept and up to date? (c237)

  Yes

  No

  N/A

• Has a Safe Work Method Statement (SWMS) been prepared for the work? (c299)

  Yes

  No

  N/A

• Is the SWMS being followed? (c300)

  Yes

  No

  N/A

• Are all controls and instruments clearly labelled, marked and operating correctly - including lights, horn, emergency cutoff, brakes, gauges etc.? (c210)

  Yes

  No

  N/A

• Is there a fire extinguisher fitted? (c43)

  Yes

  No

  N/A

• Has routine maintenance been performed? (c213)

  Yes

  No

  N/A

• Have the major inspections been completed as per the manufacturer's specifications? (c213)

  Yes

  No

  N/A

• There are no obvious signs of oil/fluid leaks? (c214)

  Yes

  No

  N/A

• Are reverse alarm and warning devices fitted? (c212)

  Yes

  No

  N/A

• Is a seat belt fitted and in use? (c206)

  Yes

  No

  N/A

• Are controls in place to separate pedestrians from moving plant and machinery? (c215)

  Yes

  No

  N/A

Power/Hand Tools

• Are tools being used for their intended purpose? (c206)

  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? (c39)

  Yes

  No

  N/A

• Are any guards and safety devices fitted and not altered? (c208)

  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? (c198)

  Yes

  No

  N/A

• Is there a logbook kept on the pump and available for inspection? (c237)

  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? (c39)

  Yes

  No

  N/A

• Has the line hand received the same inductions? (c39)

  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? (c260)

  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? (c237)

  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? (c202)

  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? (c39)

  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? (c43)

  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? (c40 & 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? (c210)

  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? (c306 & AS1657)

  Yes

  No

  N/A

• Is the floor of the car and all landings free of materials and debris? (s20 & c40)

  Yes

  No

  N/A

• is the risk of falling objects adequately controlled at each landing? (c55)

  Yes

  No

  N/A

• Is the risk of falls adequately controlled at each landing? (c78)

  Yes

  No

  N/A

All Cranes

• Is the crane registered? (c266)

  Yes

  No

  N/A

• Are all records kept on site? (c237 & AS 2550.1, 6.2)

  Yes

  No

  N/A

• Are regular maintenance checks done by a competent person? (c235 & 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? (WHS Regs 214, AS 2550.1-4.5)

  Yes

  No

  N/A

• Is 10kPa overhead protection provided to sheds and amenities? (c55)

  Yes

  No

  N/A

• Are drivers and doggers 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? (WHS Regs Schedule 5)

  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

• Are hazardous materials correctly labelled? (c341)

  Yes

  No

  N/A

• Are current safety data sheets on site and easily accessible? (c344)

  Yes

  No

  N/A

• Is there a hazardous chemicals register kept on site and up to date? (c346)

  Yes

  No

  N/A

• Is there signage to warn of hazardous chemical risks? (c353)

  Yes

  No

  N/A

• Are there measures in place to contain and manage spills? (c357)

  Yes

  No

  N/A

• Is there appropriate fire protection/firefighting equipment for the types of hazardous chemicals on site? (c359)

  Yes

  No

  N/A

• Is correct safety equipment/PPE provided, maintained and accessible? (c362)

  Yes

  No

  N/A

• Are workers trained and supervised in the correct handling of hazardous chemicals? (c379)

  Yes

  No

  N/A

Asbestos

• Have workers been trained in asbestos awareness? (c39 & c445)

  Yes

  No

  N/A

• Has asbestos been discovered at the workplace? (c419)

  Yes

  No

  N/A

• Have WorkCover been notified of removal? (c466)

  Yes

  No

  N/A

• Has an occupational hygienist been engaged? (c422)

  Yes

  No

  N/A

• Has a licensed removalist been contracted to remove asbestos? (c458)

  Yes

  No

  N/A

• Have workers been trained? (c445)

  Yes

  No

  N/A

• Is there an asbestos management plan in place? (c429)

  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? (c425)

  Yes

  No

  N/A

• Does the register include;

• Regular reviews and updating? (c426)

  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? (c464)

  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? (c473)

  Yes

  No

  N/A

• Is there a clearance certificate on site? (c474)

  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

• Additional Photos

  Media

• Notes

• Signed off by

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