Information

  • Site Name / Stage

  • Job No. :

  • Document No.

  • Client / Contractor

  • Conducted on

  • Prepared by

  • Location

PRE COM / EARTHWORKS

  • WEATHER

  • SITE CONDITIONS

  • TRAFFIC MANAGEMENT

  • FENCING & O H &S SIGNAGE

1.0 PRE-COMMENCEMENT

  • Have drawings been been approved for construction & issued to contractor

  • Has contractor submitted TMP, PMP & CEMP to relevant authorities where required.

  • Has pre-commencement meeting occurred with contractor, BPD and relevant authorities representative on site.

  • Has the Site been fenced to Developer / Authority OH&S requirements

  • Have block pegs and TBM's been installed

2.0. ACTIVITY : DEMOLITION, EARTHWORKS, EXCAVATION.

  • Demolition / Stripping status

  • Bulk Earthworks, Cut / Fill status

  • Wetland Excavation and clay liner placement

  • Road Boxing Status

  • Grading / Topsoiling Status

2.1 Works - Earthworks, Excavation

  • Are truck / scraper routes around site clearly designated and separate from public access areas.

  • Is fill being placed in layers and compacted as per specification.

  • Does clay lining material meet Wetland specification

  • Are compaction tests being conducted to specified Level by NATA registered tester.

  • Is ground water being managed in an approved manner.

  • Ia storm water runoff being managed in an approved manner.

2.2 Safety - Earthworks, Excavation

  • Does the contractor have utilities / services plans on site.

  • Does plant and equipment have suitable warning lights and reversing beepers

  • Are trucks adhering to worksite speed restrictions

  • Are personnel in the vicinity of operating plant wearing high vis clothing and helmets where required.

2.3 Environmental - Earthworks, Excavation.

  • Is there provision to minimize dust / mud from leaving the site.

  • Do stockpiles have adequate silt runoff protection.

  • Are environmental No Go areas fenced where required.

  • Are silt traps in place to prevent silt build up in previously installed drainage system.

  • Does plant / equipment / pumps meet EPA noise requirements for volume, location relative to public and work hours.

SEWER

3.0 ACTIVITY : SEWER

  • Sewer Sub Contractor

  • Sewer Retic Status

  • Start Date :

  • Completion Date :

  • Pump Station Status

  • Start Date :

  • Completion Date :

3.1 Works - Trenching, Pipelaying, Manholes, Backfill

  • Does the sewer contractor have latest revision construction issue drawings.

  • Are materials as specified and stored correctly on site

  • Is there an accredited pipe layer on site.

  • Are trench widths adequate for pipe size/ type

  • Is the bedding material & thickness within tolerance and being compacted correctly

  • Are pipes being installed in accordance with design specification and manufacturers recomendations.

  • Is welding being carried out by accredited personnel in a sheltered area

  • Are clearances to other services being maintained as per specification.

  • Does trench backfill material comply with standard drawings and specifications

  • Is mechanical compaction being carried out to specification within the support zone and around MH, MS, IS, Hydrants,Valves and Stormwater Pits.

  • Is compaction testing being carried out but NATA registered tester where required.

  • Has the concrete been placed and vibrated to specification

  • Is the surface finish of manhole walls satisfactory.

  • Are lids / covers as per design and correct rating.

3.2 Safety - Trenching, Pipelaying, Manholes, Backfill

  • Does the contractor have utilities / services plans on site.

  • Does plant and equipment have suitable roll over protection, warning lights and reversing beepers

  • Is a qualified mine manager on site during all excavations

  • Is ground support suitable for the ground conditions and depth of excavation

  • Are workers provided with a ladder or other means of access and egress where required.

  • Are hats and vests being worn by workers where required

  • Are trenches barricaded and made safe when left open.

  • Is lifting equipment suitable for the works being carried out.

  • Are mobile crane wire ropes, slings, shackles, hooks and outrigger pad set up OHS and Code of Practice compliant.

WATER

4.0 ACTIVITY : WATER

  • Water Sub Contractor

  • Water Retic Status

  • Start Date :

  • Completion Date :

  • Property Services

4.1 Works - Trenching, Pipelaying, Backfill, Surface Fittings

  • Does the water contractor have latest revision construction issue drawings

  • Are materials as specified and stored correctly on site.

  • Is there an accredited pipe layer on site.

  • Are trench widths adequate for pipe size/ type

  • Is the bedding material & thickness within tolerance and being compacted correctly

  • Are pipes being installed in accordance with design specification and manufacturers recomendations.

  • Are clearances to other services being maintained as per specification.

  • Does trench backfill material comply with standard drawings and specifications

  • Are lids / covers as per design and set correctly.

  • Are thrust restraints being installed as per design where required.

  • Are property services being installed as per design and specification for DW / NDW

4.2 Safety - Trenching, Pipelaying, Backfill, Surface Fittings

  • Does the contractor have utilities / services plans on site.

  • Does plant and equipment have suitable warning lights and reversing beepers

  • Is ground support suitable for the ground conditions and depth of excavation

  • Are workers provided with a ladder or other means of access and egress where required.

  • Are hats and vests being worn by workers where required

  • Are trenches barricaded and made safe when left open.

  • Is lifting equipment suitable for the works being carried out.

DRAIN / ELEC / COMS

5.0 ACTIVITY : DRAINAGE , ELECTRICAL , COMMUNICATIONS.

  • Drainage Contractor

  • Drainage Works Status

  • Electrical Contractor

  • Electrical / Comms Trenching Status

  • Electrical Retic Status

  • Comms Contractor

  • Comms Status

5.1 Works - Trenching, Pipelaying, Backfill, Surface Fittings

  • Is the bedding material & thickness within tolerance and being compacted correctly

  • Are pipes / conduits / pits being installed in accordance with design spec and manufacturers recommendations.

  • Are clearances to other services being maintained as per specification.

  • Does trench backfill material and compaction comply with standard drawings and specifications.

  • Are trench widths adequate for pipe size/ type

  • Are lids / covers as per design and set correctly.

5.2 Safety - Trenching, Pipelaying, Backfill, Surface Fittings

  • Does the contractor have utilities / services plans on site.

  • Does plant and equipment have suitable warning lights and reversing beepers

  • Is ground support suitable for the ground conditions and depth of excavation

  • Are workers provided with a ladder or other means of access and egress where required.

  • Are hats and vests being worn by workers where required

  • Are trenches barricaded and made safe when left open.

  • Is lifting equipment suitable for the works being carried out.

PAVEMENT

6.0. ACTIVITY : PAVEMENT

  • Cap rock Status

  • Conduits / AG Status

  • Class 3 FCR Status

  • Class 2 FCR Status

  • Asphalt Prep - Prime, SAMI Status

  • Asphalt Status

6.1 Works - Pavement

  • Are conduits and AG drains at correct depth

  • Does trench backfill material comply with standard drawings and specifications

  • Does pavement material comply with plans, standard drawings and specifications.

  • Is compaction equipment adequate to achieve specified results.

  • Is crushed rock being placed in layers and compacted as per specification.

  • Are compaction tests being conducted to specified Level by NATA registered tester.

  • Is the weather suitable for priming or placing asphalt.

6.2 Safety - Pavement

  • Does plant and equipment have suitable warning lights and reversing beepers

  • Are personnel in the vicinity of operating plant wearing high vis clothing and helmets where required.

  • Are asphalt crews employing appropriate protective equipment.

CONCRETE

7.0. CONCRETE

  • Kerb and Channel Status

  • Footpath and Crossover Status

  • Parking Bay Status

  • Concrete Laneway / Extended Driveway Status

  • Roundabout Status

  • Pattern Paving Status

  • Retaining Wall Status

  • Concrete Endwall / Headwall Status

7.1 Works - Concrete

  • Are weather conditions suitable for placing concrete.

  • Are access routes for trucks clearly defined

  • Is boxing depth and crushed rock bedding as per specification

  • Is form work adequate for the structure being constructed.

  • Is reinforcing as per specification and installed correctly.

  • Are retaining wall post holes dia / depth correct.

  • Are kerb markings for services being installed.

7.2 Safety - Concrete

  • Are concretors wearing appropriate PPE.

  • Does plant and equipment have suitable warning lights and reversing beepers

ROCKWORK

8.0. ACTIVITY : ROCKWORK / MISCELLANEOUS

  • Rock Wall Status

  • Rock Endwall / Headwall Status

  • Rock Beaching Status

  • Retaining Wall Status

  • Porphrey Stone Paving Status

8.1 Works - Rockwork, Miscellaneous

  • Are rocks suitable for intended purpose and of appropriate size/ grading.

  • Are rocks sitting on concrete cushions over pipe ends

  • Are rocks being placed to specification and grouted as required.

  • Is reinforcing being installed as per specification.

8.2 Safety - Rockwork, Miscellaneous

  • Are contractors wearing appropriate PPE.

  • Are personnel in the vicinity of operating plant wearing high vis clothing and helmets where required.

  • Does plant and equipment have suitable warning lights and reversing beepers

COMMENTS / PHOTOS

COMMENTS / PROGRESS / INSTRUCTIONS.

  • COMMENTS

  • PHOTOS

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.