Title Page
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Conducted on
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Prepared by
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Location
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Date:
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Time:
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Audited by:
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Address:
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Description of Works:
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Name of Contractor:
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Name of Supervisor:
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Names of Team Members:
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Worksite Information
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Vehicle Rego:
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Photo of License Plate
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LICENCES AND QUALIFICATIONS FOR THE WORK TASK BEING COMPLETED AND ADHEARANCE TO REGULATIONS
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Do all team members ave appropriate driving licences, (visual check)?
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Photo of relevant drivers license
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ESI level 2 / Limits of approach
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Are Safe Approach Distances being adhered to in accordance with Electrical Safety Rules for the Vesi distribution network?
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Traffic Management
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High Risk elevated work platform licence
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Are all staff included on contractors training Matrix? (Council officer to cross reference training matrix)
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Are training units appropriate for work Role ? (Council officer to cross reference training matrix)
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PERSONAL PROTECTIVE EQUIPMENT
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Is SunSmart Workwear being worn by all team members?
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Is safety footwear being worn by all team members?
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Are safety vest worn by all team members and are they VicRoads approved if working on a declared road?
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Is earing protection being worn? (if required)
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Is eye protection being worn? (if required)
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Is head protection being worn? (if required)
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Is hand protection being worn? (if required)
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Are chainsaw pants or chaps being worn where required?
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Where applicable is additional PPE being worn appropriate to the task?
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SITE SET UP including TRAFFIC & PEDESTRIAN MANAGEMENT
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Is suitable traffic and pedestrian management being used for te site?
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Are the signs in use suitable for the task and in good condition?
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Are all fuel and cemical containers labelled & stored appropriately?
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Has the Pre-start / Log Book entry been completed? (spot check two items)
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Are audible and visible warning devices operational?
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Does the plant/equipment have appropriate decals (i.e. CoC logo and fleet number)
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Are all onsite veicles/plant registered?
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Is the vehicle clean and presentable inside and out?
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Is there any visible damage to to vehicle (both inside and out)?
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Are seat belts worn wilst operating ride on equipment?
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Has an onsite risk assessment / hazard assessment checklist been completed?
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Has a Job Safety Analysis (or similar), been completed for the task?
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Is the worksite free from trip hazards?
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EMERGENCY RESPONSE Is a phone available ?
- Yes
- No
- N/A
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Is there a first aid kit available? When was it last replenished?
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Is there a trained first aider on site?
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Are fire extinguisers available? (were required)
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Auditor Signature:
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Team Rep/Contractor Signature:
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Item No
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Action Item
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Responsible Officer (responsible for close out actions)
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Close Out Date
