Clearvision Site Safety Improvement V4

• simPRO Job No.

• ROW, SDU, MDU or Other

  ROW

  SDU

  MDU

  Other

• What work was completed

• Site Address

• Prepared by

• Vehicle Rego

• Lead Tech

• Assistant Tech

• Conducted on

  Date

Site Observations

• Is the site meeting safety expectations?

  Safe

  At-Risk

  Significant At-Risk

• Was the Induction helpful or not?

  Safe

  At-Risk

  Significant At-Risk

• Have they identified and controlled all of the significant hazards?

  Safe

  At-Risk

  Significant At-Risk

• Are there any new hazards to consider?

  No

  Yes

• Was the site tidy or presented well?

  Safe

  At-Risk

  Significant At-Risk

• Are the techs confident to do the job safely?

  Safe

  At-Risk

  Significant At-Risk

• PPE (As per task requirements)?

  Safe

  At-Risk

  Significant At-Risk

• Did they explain the task and controls well?

  Yes

  No

• Has the JSA captured these controls?

  Safe

  At-Risk

  Significant At-Risk

• What are the techs considering, from a safety perspective, when they start the task?

  Safe

  At-Risk

  Significant At-Risk

• Do the techs consider other people (public, workers, home owners) when they do their tasks?

  Safe

  At-Risk

  Significant At-Risk

• Is the other (vehicle, generator, tools etc) equipment tidy and in good condition?

  Safe

  At-Risk

  Significant At-Risk

Site Safety Improvements

• Please list the Good Safety Behaviors?

• Good Safety Behaviors

  Media

• Unsatisfactory Behaviors (e.g. hazards, controls and at-risk behavior)

• Unsatisfactory Behaviors (e.g. hazards, controls and at-risk behavior)

  Media

• Safety Discussion and Immediate Actions required?

• Photos of rectifications

  Media

• Future Improvements/ Training?

Acknowledgement

• Manager Name

  Sign
Technician

• Technician Name

  Sign