Chorus Health & Safety Snapshot Form - Field

• Date

  Date

• Audit Title

• Serco

  Visionstream

  Downer

  Transfield

  UCG

• Contractor

• Completed by

• Location
  Address

• Job Number (FFP, iTools, VS etc)

• Onsite Supervisor

• WAP#

• B4UDIG sighted?

• Brief description of works at time of inspection

General

• Are Chorus signs erected for community where applicable and dated? (UFB ONLY, take photo evidence)

  Yes

  No

  N/A

• Are personnel inducted and signed onto a daily prestart / JSA (job safety analysis) / tailgate / toolbox? <br>(View documents and ascertain signature page to ensure personnel have signed on)

  Yes

  No

  N/A

• Are all the people on the worksite wearing compliant mandatory PPE? <br>(Hard hat, safety boots, hi viz vest, safety eye wear, long pants, long sleeved shirt)

  Yes

  No

  N/A

• Is additional PPE available for the task and fit for purpose?<br>(Safety eyewear/goggles, full face shield for cutting concrete, gloves. Harness for working at height. Gloves for general cutting, tripod, winch. Coveralls, P2 mask for asbestos works. Calibrated gas detector. 2way radios for traffic control etc.)

  Yes

  No

  N/A

• Have site specific hazards been identified and controlled? <br>(Review daily prestart / JSA (job safety analysis) / tailgate / toolbox and SWMS (safe work method statement). TAKE PHOTOS)

  Yes

  No

  N/A

Training and Competency

• Do crew members have evidence of WTCs? (E.g. Passport, certificates, licenses)

• Are these relevant to the task being undertaken?

• Take picture of sign on if easier to record names

  Media

• If operator/technician has their WTC (wheels, tracks and rollers) or verification card on them then take a photo:

  Media

Documentation

• Are appropriate registers completed and on site?<br>(SDS, plant/equipment, ladders/lifting, gas detector calibration, electrical equipment etc)

  Yes

  No

  N/A

• Are documented SOP (safe operating practices) available and being followed? (Check dates/versions etc)<br>NOTE: WORK MUST HALT IF ANSWER IS NO

  Yes

  No

  N/A

• Are relevant and mandatory permits in place?<br>(E.g. Excavation/drilling, working at heights, hot works, confined spaces and transformer)<br>NOTE: WORK MUST HALT IF ANSWER IS NO

  Yes

  No

  N/A

• Are relevant consents (e.g. Close approach) on site and sighted?<br>NOTE: WORK MUST HALT IF ANSWER IS NO

  Yes

  No

  N/A

• Are traffic management plans available, current and approved?<br>NOTE: WORK MUST HALT IF ANSWER IS NO

  Yes

  No

  N/A

• Are up to date, valid and coloured service plans available on site? <br>NOTE: WORK MUST HALT IF ANSWER IS NO

  Yes

  No

  N/A

Environment

• Is the worksite clean and tidy? (E.g. No trip hazards)

  Yes

  No

  N/A

• Is dust and noise managed? (E.g. Water, ear muffs etc)

  Yes

  No

  N/A

• Are sediment controls in place and effective? (E.g. Filter cloth, sand socks)

  Yes

  No

  N/A

• Are spill kits available and accessible?

  Yes

  No

  N/A

• Are hazardous substances stored safely in bunded trays and SDS available for each?

  Yes

  No

  N/A

• Are pedestrian ramps safe and secure? (E.g. Interlocked securely, flat and with solid foundations)

  Yes

  No

  N/A

Plant / Equipment / Vehicles

• Is an exclusion zone set up around mobile plant? <br>(Aka site isolation and pedestrian corridor and/or are spotters in place)

  Yes

  No

  N/A

• Are seat belts being worn in moving plant?

  Yes

  No

  N/A

• Do operators have valid licenses? (E.g. Full drivers license, Wheels tracks and rollers)<br>-> THIS IS MANDATORY

  Yes

  No

  N/A

• License photos:

  Media

• Have daily plant prestarts been completed and documented by they operator? (View and take photos)

  Yes

  No

  N/A

• Do vehicles have current WOFs and registrations?

  Yes

  No

  N/A

• Is site equipment in good condition?<br>(E.g. No obvious defects, cracked handles, bent hammers, frayed leads)

  Yes

  No

  N/A

• Is portable electrical equipment tested and tagged and in date (3 monthly)?<br>(E.g. Generators, leads, residual current device, air compressor etc)

  Yes

  No

  N/A

• Electrical equipment:

  Media

• Is a ladder register available and on site? (Check for testing certification)

  Yes

  No

  N/A

• Register photo:

  Media

• Safety equipment certified and completed in on site lifting register?<br>(E.g. Harness/lifting equipment, strops, chains).

  Yes

  No

  N/A

• Register photo:

  Media

• Are safety fences secure and suitably protecting pedestrians/excavations from unauthorised access to work areas?

  Yes

  No

  N/A

• Barrier photo:

  Media

Critical Safety Checks

• If any of the following safety critical areas are not compliant then work MUST BE STOPPED UNTIL THE ISSUE IS RESOLVED

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

• Up to date service plans not available/relevant to the works being conducted

• Work training competencies - if any certificated held on site are out of date or crew are undertaking work which they hold no valid training qualification

• Traffic Management. Plan not being followed pr pedestrian safety at risk

• Breech of Safe work methods statement (SWMS) or SOP

• Unsafe behaviour/acts/conditions (e.g. Horseplay, operating faulting equipment, not licensed to operate plant, unsafe ramps, unprotected excavations, poor exclusion zones around plant, incorrect wearing of PPE, poor sediment controls (slurry in drains etc)

• Extra worksite photo

  Media

• Actions required? (State by who and by when)

• Site representative:

  Sign

• Chorus representative:

  Sign

• Positive behaviours

• Any other comments?