Chorus Health & Safety Inspection Version 4

• Document No.

• Date

  Date

• Audit Title

• Service Company. Version

• Contractor

• Completed by

• Location
  Address

• FFP#

• WAP#

• B4UDIG sighted

• Onsite Supervisor

• Brief description of works at time of inspection

General

• Are Chorus signs displayed for community where applicable?

  Yes

  No

  N/A

• Are all the people on the worksite wearing compliant PPE. Hard hat, safety boots, hi viz vest, safety eye wear, long pants, long sleeved shirt?

  Yes

  No

  N/A

• Are you requested to sign on to a daily prestart / JSA. Are hazard controls discussed?

  Yes

  No

  N/A

• Coloured A3 plans on site?

  Yes

  No

  N/A

• Is the supervisor controlling critical activities experienced?

  Yes

  No

  N/A

• Work activity photo

  Media

• Work activity photo

  Media

• Work activity photo

  Media

• Work activity photo

  Media

• Work activity photo

  Media

• Work activity photo

  Media

• Work activity photo

  Media

• Work activity photo

  Media

Working at height

• Is the site activity involved in working at heights e.g. aerial pole work?

  Yes

  No

  N/A

• Are persons trained? Must sight tickets.

  Yes

  No

  N/A

• Are fall hazards identified and controls in place?

  Yes

  No

  N/A

• Photo of controls

  Media

• Harnesses, lanyards and other fall arrest equipment been inspected prior to works commencing?

  Yes

  No

  N/A

• Are guards, rails or barriers in place?

  Yes

  No

  N/A

• An exclusion zone set up?

  Yes

  No

  N/A

• Is there a permit in place for works over 5 metres?

  Yes

  No

  N/A

• For pole work has the pole been tested?

  Yes

  No

  N/A

• Is there a rescue plan in place and adequate rescue equipment readily accessible on site?

  Yes

  No

  N/A

• Comments

Excavation and Drilling

• Are excavation or drilling activities taking place on the site?

  Yes

  No

  N/A
Tap to enter information

• Excavation and drilling permit completed and available.

  Yes

  No

  N/A
Tap to enter information

• If there is no permit in place then all work on the site should be stopped until a permit is in place. This should be recorded in the comments of the audit.

• Is the permit for the current location?

  Yes

  No

  N/A
Tap to enter information

• If there is no permit in place then all work on the site should be stopped until a permit is in place. This should be recorded in the comments of the audit.

• Close approach permit is in place if plant or people are working within 3 metres of overhead cables?

  Yes

  No

  N/A
Tap to enter information

• If there is no permit in place then all work on the site should be stopped until a permit is in place. This should be recorded in the comments of the audit.

• Have all current proximity permits been obtained from utility owners?

  Yes

  No

  N/A
Tap to enter information

• If there is no permit in place then all work on the site should be stopped until a permit is in place. This should be recorded in the comments of the audit.

• Only techniques approved on the permits being used?

  Yes

  No

  N/A
Tap to enter information

• If the site methods do not match the permit in place then all work on the site should be stopped until clarification of the methods is discussed. This should be recorded in the comments of the audit.

• Are service mark outs visible?

  Yes

  No

  N/A

• Excavations deeper than 1.5 metres have been notified to Worksafe NZ?

  Yes

  No

  N/A
Tap to enter information

• If no notification is in place then all work on the site should be stopped until notification has been made. This should be recorded in the comments of the audit.

• Are trenches greater than 1.5 metres deep, battered, benched or supported?

  Yes

  No

  N/A
Tap to enter information

• If there are not trench supports in place then all work on the site should be stopped until measures have been agreed and implemented to support the trench. This should be recorded in the comments of the audit.

• Has a services spotter been allocated to each excavator?

  Yes

  No

  N/A

• Comments

Traffic Management

• Does the activity being carried out require traffic or pedestrian management?

  Yes

  No

  N/A
Tap to enter information

• Is there a copy of the current traffic management plan on site?

  Yes

  No

  N/A

• Traffic management set up is correct according to the approved traffic management plan?

  Yes

  No

  N/A

• Is there an escape route for the traffic contoller?

  Yes

  No

  N/A

• Is the STMS contact number listed?

  Yes

  No

  N/A

• Is there and after hours traffic management plan in place?

  Yes

  No

  N/A

• Are the cones and barriers being used in good condition?

  Yes

  No

  N/A

• PPE selected, used and suitable for the activity and environmental hazards present?

  Yes

  No

  N/A

• Are unattended excavations backfilled, plated or fenced?

  Yes

  No

  N/A

• Is the worksite (including footpaths and roads) clear and free from debris, rubbish and obstructions?

  Yes

  No

  N/A

• Comments

Plant and Equipment (including mobile plant)

• Are vehicles or mobile plant present on the worksite?

  Yes

  No

  N/A
Tap to enter information

• Has a daily plant prestart been documented by the operator prior to operating the machine?

  Yes

  No

  N/A

• Are site vehicles parked safely? e.g. on a decline

  Yes

  No

  N/A

• If work vehicles are parked on a hill are wheels chocked, handbrake engaged etc?

  Yes

  No

  N/A

• WOF/COF/RUC/Registration current on all vehicles?

  Yes

  No

  N/A

• Drivers and operators have the correct vehicle licences and endorsements? e.g. WTR

  Yes

  No

  N/A

• Drivers and operators are wearing seatbelts on moving vehicles?

  Yes

  No

  N/A

• Ares safe reversing procedures being followed?

  Yes

  No

  N/A

• Comments

Public Safety and Pedestrian Access

• Does the site activity effect pedestrians movement or expose the general public to risk?

  Yes

  No

  N/A
Tap to enter information

• Is safe pedestrian access maintained around the work area?

  Yes

  No

  N/A

• Are all trenches and pits cordoned off?

  Yes

  No

  N/A

• Are appropriate barriers in place?

  Yes

  No

  N/A

• All manholes and pits are barriered or covered?

  Yes

  No

  N/A

• Does the pedestrian route cater for people with disabilities and children?

  Yes

  No

  N/A

• Mobile plant and machinery operations are segregated for the pedestrian routes?

  Yes

  No

  N/A

• Ramps are compliant with pedestrian route requirements?

  Yes

  No

  N/A

• Comments

Confined Spaces

• Does the activity require access to confined spaces?

  Yes

  No

  N/A
Tap to enter information

• Is there a confined space management plan on site

  Yes

  No

  N/A

• Is there a trained confined space supervisor on site?

  Yes

  No

  N/A

• Are confined space permits in use?

  Yes

  No

  N/A

• Is there a standby person outside the confined space at all times the confined space is occupied?

  Yes

  No

  N/A

• Is there an emergency response plan detailed and available on the site?

  Yes

  No

  N/A

• Is certified emergency rescue equipment available?

  Yes

  No

  N/A

• Was atmospheric testing completed before each entry to the confined space?

  Yes

  No

  N/A

• Is continuous atmospheric testing in place at all times the confined space is occupied?

  Yes

  No

  N/A

• Does the atmospheric testing equipment have a current certification?

  Yes

  No

  N/A

• Comments

Environmental Management

• Site specific tree plan on site and signed off by the local authority?

  Yes

  No

  N/A

• Spill response plan available and understood?

  Yes

  No

  N/A

• Spoil containment and removal (including stockpiles) managed?

  Yes

  No

  N/A

• Is any stored backfill located more than 500mm from environmentally sensitive areas? (drains, streams, dumps leading to stormwater pits)

  Yes

  No

  N/A

• Is all back fill stored on top of drop sheets?

  Yes

  No

  N/A

• Are fibre off cuts and ribbonet cut offs collected for recycling?

  Yes

  No

  N/A

• Are safety fences secured with cable ties? (string / wire not acceptable )

  Yes

  No

  N/A

• Dust and noise on site is mnimised or eliminated?

  Yes

  No

  N/A

• Comments

Hazardous Substance Management

• Is there a hazardous substance register held on site?

  Yes

  No

  N/A

• Are SDS available onsite for each hazardous substance?

  Yes

  No

  N/A
Tap to enter information

• Are the SDS dated within the last 5 years?

  Yes

  No

  N/A

• Comments

Critical Safety Checks

• If any of the following safety critical areas are not compliant then work at the site should be postponed / ceased until the area of concern is addressed

• Permits / consents of work not in place e.g. working at heights, excavation / drilling, confined space work

• No qualified STMS on site (LV2) - Pedestrian safety at risk

• Breech of Safe work methods statement (SWMS)

• Unsafe behaviour where potential to injure a person e.g. working at height with no fall protection in place, not trained.

• Comments

• Worksite photo

  Media

• Worksite photo

  Media

• Worksite photo

  Media

• Worksite photo

  Media

• Worksite photo

  Media

• Worksite photo

  Media

• Site Representative

• Tap to enter information

  Sign

• Chorus Representative

• Tap to enter information

  Sign

• Positive behaviours

• Any other comments?