Information

  • Document No.

  • Project Number/TOW and address

  • Conducted on

  • Prepared by

  • Location of First Aid Kit and Fire Extinguisher

  • Name of First Aider

  • Site Emergency Assembly Area

  • Personnel

  • Any work on Asbestos materials? If yes, STOP WORK and Call Team Leader/Director

  • Do we have to do Civil Works to the Lead-In? If so - lists SWMS that apply below.

  • Dial Before You Dig Obtained? You need to check in Google Drive for this in the specific job folder. NO ground penetration is allowed without this.

  • All Plant Operators licenced and accredited? Check Google Drive if in doubt.

  • All workers hold current: Construction Awareness Card (white/blue card), COMMNECTIONS QLD induction , Asbestos awareness certificate, NBN Safety and Awareness Training?). Check Google Drive if in doubt. Workers are not allowed on site without ALL of these certs.

Site Conditions

  • Ground surfaces - is there a risk of trips and falls? If so, list SWMS that apply.

  • Are there potentially dangerous animals or plants? If so, list SWMS that apply.

  • Are there electrical hazards or ignition sources? If so, list SWMS that apply.

  • Use of hazardous substances or dangerous goods? If so - refer to MSDS for safe handling and what to do in the event of an emergency.

  • Biological hazards - eg syringes, contaminated water? If so, list SWMS that apply.

  • Pole check needed? If so, list SWMS that apply.

  • Will you be working in confined spaces? If so, list SWMS that apply.

  • Are you working on or near a service station? Is there a danger of fumes near pit/manhole/ducts? If so, list SWMS that apply.

  • Will you be making excessive noise? Have you informed the neighbours? List SWMS/Management techniques that apply.

Climate Conditions

  • Is there sufficient light for all tasks? If not, list safety procedures/SWMS that apply.

  • Are climate conditions suitable for performing tasks? If not, list SWMS that apply.

Environmental Hazards

  • Contaminated soil/water? If so, list SWMS that apply.

  • Pesticides/Insecticides used? If so, list SWMS/MSDS that apply.

  • Stormwater or sediment controls? Dewatering? If so, list SWMS that apply.

  • Air quality? Dust emissions? Noise or vibrations? If so, list SWMS that apply.

  • Disturbance to flora/fauna? Potential for spreading of weeds/pests? If so, list SWMS that apply.

  • Will you be disposing of waste from site? If so, where/how?

Traffic Management

  • Traffic/Pedestrian management needed? Refer to Traffic Management Plan and write scenario below.

Plant

  • Plant/Equipment used? Have the pre-start checks been completed?

  • Elevated Work Platform being used? Refer to SWMS.

  • Is a gas detector needed?

  • Are there overhead electrical hazards? If so, list SWMS that apply.

Manual Handling

  • Possibility of awkward postures, pushing or pulling? If so, list SWMS that apply.

  • Will you be lifting, lowering or will there be sudden body movements? If so, list SWMS that apply.

  • Will you be subjected to sustained vibrations? If so, list SWMS that apply.

Working at Heights

  • Is there ladder use? If so, list SWMS that apply.

  • Are there unprotected ledges on site resulting in fall hazards? If so, list SWMS that apply.

Working with Tools

  • Are power tools being used for drilling/cutting? If so, list SWMS that apply.

Other safety concerns/hazards.

  • List any other safety concerns/hazards.

EMERGENCY RESPONSE

  • EMERGENCY CONTACT NUMBERS

    POLICE-FIRE-AMBULANCE. 000

    For local Energy, Gas & Water Companies see FSA Plan

    Project Incident Reporting. CONTACT REGIONAL HSE ADVISOR

    WIRES Wildlife Protection Service. 1300 094 737

    Dial Before you dig(DBYD). 1100

  • Address of nearest Hospital
  • Hospital Phone Number

  • In the event of an emergency, proceed to the evacuation point. Ensure all your team members get to safety.

    1. Ensure first aid is provided
    2. Call the Regional HSE Advisor to report emergency/incident
    3. Call your Visionstream supervisor to report an emergency/incident

    ALL INCIDENTS MUST BE REPORTED

Sign-on

  • 1. All visitor must sign onto the START CARD
    2. All visitors must be briefed on all work site hazards, the evacuation point location and procedure and PPE requirements.
    3. All visitors to site must be escorted at all times by an inducted staff member and MUST and must not undertake any physical work while onsite at any time.

  • Employee sign on
  • Employee

  • Visitor Sign on
  • Visitor

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.