CFMEU Victoria - Crystalline Silica Dust

• Employer/builder

• Employer Representative/ Phone number/ Position

• Name of site and Address:
  Address

• Has an ARREO permit been requested?

  Yes

  No

  N/A

• Has WorkSafe attendance been requested? Name of inspector if applicable

  Yes

  No

  N/A

• Has a WorkSafe inspector previously attended the site? If so, Name and date of attendance?

  Yes

  No

  N/A

• Conducted on

  Date

• Prepared by

• Yes

  No

  N/A

• Is high risk Crystalline Silica work or Crystalline Silica processes taking place onsite? (OHS Reg 319B, OHS Reg 319C)

  Yes

  No

  N/A

• Does the employer conduct health monitoring checks (must be carried out if employee is exposed to ANY hazardous substance inclusive of crystalline silica). OHS Reg 169

  Yes

  No

  N/A

• Is Crystalline Silica reasonably likely to become airborne and exceed HALF (0.01mg/m3 TWA) the exposure standard for respirable crystalline silica? Exposure LIMIT = 0.02mg/m3 TWA (over 8 hour period). (OHS Reg 319C (a)(b) )

  Yes

  No

  N/A

• Is the employer ensuring its employees/sub contractors are not exposed to atmospheric concentration of silica dust? (OHS Reg 165)

  Yes

  No

  N/A

• is the employer keeping written records of all atmospheric monitoring & silica work conducted at the workplace (OHS Act s22 (1) (b), OHS Reg 168, OHS Reg 319K)

  Yes

  No

  N/A

• are the records readily accessible to all relevant employees & HSR's (OHS Reg 319K (3) (a) (b), OHS Reg 167)

  Yes

  No

  N/A

• Has the HSR been consulted when identifying hazards or implementing risk controls (OHS Act s35 (4) )

  Yes

  No

  N/A

• Is there an SDS sheet available for manufactured materials stating crystalline silica content? (eg brick, concrete, tiles, engineered stone, finely crushed rock) (OHS Reg 319G (1)(2) )

  Yes

  No

  N/A

• If the product cannot be clearly identified for silica content, does the employer treat the process as high risk silica work until proven otherwise? (OHS Reg 319J (4) )

  Yes

  No

  N/A

• Have written records been made readily available to the HSR / employees (such as risk assessments & hazard control statements)?

  Yes

  No

  N/A

• Is there a quarrying or tunnelling process being undertaken onsite?

  Yes

  No

  N/A

• if tunnelling or quarrying, has the employer collected samples of materials to be used prior to work commencing? (OHS Reg 319O (a) )

  Yes

  No

  N/A

• has the samples collected been sent for analysis by a NATA approved hygienist (suitably competent person)? Has the proportion of crystalline silica been identified as a percentage in each sample? (OHS Reg 319O (b) )

  Yes

  No

  N/A

• Has the employer conducted a RISK ASSESSMENT to identify if the process/es are high risk silica work? (OHS Reg 319J (1) a & b (2) a-f )

  Yes

  No

  N/A

• does the risk assessment include the specific tasks / processes undertaken with material containing c silica OHS Reg 319J (2) (a)

  Yes

  No

  N/A

• does it include the form of c silica to be used? OHS Reg 319J (2) (b)

  Yes

  No

  N/A

• does it include the proportion of silica in the material? (OHS Reg 319J (2) (c) )

  Yes

  No

  N/A

• does it include the previous atmospheric monitoring results? (OHS Reg 319J (2) (d) )

  Yes

  No

  N/A

• does it include the likely frequency and duration of exposure to silica dust? (OHS Reg 319J (2) (e) )

  Yes

  No

  N/A

• does it include any information about incidents/illness/disease associated with exposure to silica dust? (OHS Reg 319J (2) (f) )

  Yes

  No

  N/A

• Has a separate crystalline silica HAZARD CONTROL STATEMENT been prepared prior to work commencement? (OHS Reg 319D, OHS Reg 319L, OHS Reg 319N)

  Yes

  No

  N/A

• If construction, do the SWMS clearly identify the works as high risk crystalline silica work, and are the silica risks, hazards and controls related to the task clearly identified and addressed in the SWMS (OHS Reg 319L (3) )

  Yes

  No

  N/A

• Has the hazard control statement been reviewed and revised to include any subsequent changes to the workplace, control measures that are not adequately controlling risk or after any incident that may have occurred during the silica work? (OHS Reg 319M)

  Yes

  No

  N/A

Engineered Stone

• Is there an engineered stone process carried out at the workplace? (OHS Reg 319E)

  Yes

  No

  N/A

• Does the employer hold an engineered stone licence? (OHS Reg 319Z)

  Yes

  No

  N/A

• Is the employer a supplier of engineered stone? (319ZA)

  Yes

  No

  N/A

• as the supplier, do they keep records including names, addresses, name of product, quantity, to whom the engineered stone is supplied? (OHS Reg 319ZA (2) (a) )

  Yes

  No

  N/A

• Do they have a record of the licence number to whom the engineered stone was supplied to? (OHS Reg 319ZA (1), (2) (b) )

  Yes

  No

  N/A

• Have they kept the records for at least 5 years? (OHS Reg 319ZA (3) )

  Yes

  No

  N/A

• Has the engineered stone licence holder provided information to job applicants about health risks associated with crystalline silica dust including the need for, & details of, measures to control risks? (OHS Reg 319ZB (a) (b) )

  Yes

  No

  N/A

• Has the engineered stone licence holder provided information, instruction & training to employees who are likely to be exposed to silica risks. Inclusive of health risks & the need for proper use of control measures and their implementation. (OHS Reg 31ZC)

  Yes

  No

  N/A

• Is the engineered stone licence holder conducting health monitoring by a specialist occupational physician (OHS Reg 169, OHS Reg 319ZD)

  Yes

  No

  N/A

• Has the engineered stone licence holder provided WorkCover all health monitoring reports that relate to the health of employees at the workplace within 30 days of being received? (OHS Reg 319ZE (1) (a) )

  Yes

  No

  N/A

• Has the engineered stone licence holder provided Workcover all atmospheric monitoring results at the workplaces within 30 days of being received? ( OHS Reg 319ZE (1) (b) )

  Yes

  No

  N/A

• Has the engineered stone licence holder prepared a CONTROL PLAN prior to works being undertaken? is performed works in accordance? does it correctly identify the work undertaken? state hazards and risks? Sufficient control measures? and is that control plan reviewed and revised as necessary, made readily available to all employees? (OHS Reg 319ZF)

  Yes

  No

  N/A

• If work that requires an engineered stone licence is not performed in accordance with the engineered stone control plan for that work, the employer MUST stop work immediately or as soon as is safe to do so and not resume work until the control plan is complied with or reviewed and revised) (OHS Reg 319ZF (3) (a) (b) )

  Yes

  No

  N/A

• Has the engineered stone licence holder given all employees who have ceased employment at the workplace a written statement that contains the duration of employment and advice for the employee to maintain relevant periodical health assessments? (OHS Reg 319ZG (1) (2) )

  Yes

  No

  N/A

• Are power tools or mechanical plant used to undertake an engineered stone process? (OHS Reg 319S)

  Yes

  No

  N/A

• Has the employer ensured that employees who use the tools/mechanical plant been provided with information, instruction and training in the correct use of the equipment? (OHS Reg 319W (a) )

  Yes

  No

  N/A

• Is the power tool / mechanical plant used with an integrated water delivery system? (OHS Reg 319S (1) (a)

  Yes

  No

  N/A

• Does the integrated water delivery system deliver continuous supply of water to the point of contact with the stone while the power tool / mechanical plant is in use? (OHS Reg 319S (2) (a) )

  Yes

  No

  N/A

• if the system uses recycled/recirculated water, is it adequately treated? (OHS Reg 319S (2) (b) )

  Yes

  No

  N/A

• is the system maintained so as to eliminate / reduce any risk of exposure to silica? (OHS Reg 319U)

  Yes

  No

  N/A

• Is the power tool / mechanical plant used with an on tool dust extraction system that is commercially available such as a Dust Class H Vacuum or similar system? (OHS Reg 319S (b)

  Yes

  No

  N/A

• is the system maintained so as to eliminate / reduce any risk of exposure to silica? (OHS Reg 319U)

  Yes

  No

  N/A

• Is there local exhaust ventilation?

  Yes

  No

  N/A

• is the system maintained so as to eliminate / reduce any risk of exposure to silica? (OHS Reg 319U)

  Yes

  No

  N/A

Engineered stone Respiratory Protection Equipment (RPE)

• Have the employees been provided with RPE? (OHS Reg 319V (1) )

  Yes

  No

  N/A

• does the employer ensure that the employee uses the RPE? (OHS Reg 319V (2)

  Yes

  No

  N/A

• has the employer provided information, instruction and training in the use, fit, maintenance, and storage of the RPE? (OHS Reg 319W (b) )

  Yes

  No

  N/A

• Is compressed air or other compressed gases used to clean work areas or clothing that has been worn in the area? (OHS Act s21, 23, 24 OHS Reg 319X)

  Yes

  No

  N/A

• Additional Hazards

• Notes

• signed off by

  Sign