Title Page

  • Contract Title and #

  • Contractor

  • Location
  • Date & Time of Visit

Overview

Visible Workers on Site

  • Foreman

  • Construction Workers

  • Concreters

  • Plant Operators

  • Surveyors

  • Traffic Controllers

  • Vac truck operators

  • Other

  • Describe other

  • Describe other

  • Describe other

  • Describe other

  • Describe other

Visible Plant on Site

  • Bobcats

  • Concrete Trucks

  • Excavator(s)

  • Excavator(s)Tonnage

  • Line Markers

  • Tip-Trucks

  • Tool-Trucks

  • Traffic Control vehicles

  • Utes

  • Vac Trucks

  • Other

  • Other Plant Description

  • Other Plant Description

  • Other Plant Description

  • Other Plant Description

  • Other Plant Description

Weather Conditions

  • Temperature

  • Fine, Rain or Light Showers

  • Overcast

  • Work Stopped Due to Weather

  • Describe Conditions

Activity

  • Concreting

  • Earthworks

  • Electrical

  • Excavation

  • Formwork

  • Manhole works

  • Pipelining

  • Pipework

  • Pot-Holing

  • Restoration Works

  • Road Works

  • Signs, Lines, etc.

  • Site Works

  • Steel fixing

  • Storm Water Works

  • Testing

  • Other

  • Describe Activity

Process

Process

  • Has the Contractor performed and documented a pre start

  • Why not?

  • Visual check of licences and induction

  • Why not?

  • Check that the Safe work method statement (SWMS)/work method statement (WMS) are on site, relate to the work and have been implemented

  • Why not?

  • Safe Work Australia

  • https://www.safeworkaustralia.gov.au/

  • Check Environmental Management Plan (e.g. dewatering acid sulphate soil)

  • Why not?

  • Have underground services been identified (e.g. Dial before you dig &/or potholing)

  • Why not?

  • Have all energy sources been isolated (LOTO)

  • Why not?

  • Are relevant spotters on-site

  • Why not?

  • Have the required Traffic Management Plans (TMP’s) been approved by the relevant authority (Council, DTMR etc.)

  • Why not?

  • MUTCD QLD Part 3: Works on Roads November 2018

  • https://www.tmr.qld.gov.au/-/media/busind/techstdpubs/Traffic-management/Manual-of-Uniform-Traffic-Control-Devices/MUTCD-Pt-3-Works-on-Roads.pdf?la=en

  • Supplement - MUTCD QLD Part 3: Works on Roads November 2018 (Example diagrams)

  • https://www.tmr.qld.gov.au/-/media/busind/techstdpubs/Traffic-management/Manual-of-Uniform-Traffic-Control-Devices/MUTCD-Pt-3-Supplement.pdf?la=en

  • Are control measures in place (barricading signs,) for both vehicle traffic & pedestrians, & in accordance with the approved TMP

  • Why not?

  • Fire ant soil management in place (where relevant)

  • Why not?

  • Check that all permits and risk assessments have been filled out and implemented

  • Why not?

  • PPE in good condition and being worn

  • Why not?

  • Housekeeping adequate (including rubbish), all personnel must be mindful when working in public areas as you are representing GCWW.

  • Why not?

  • Any safety or environmental concerns

  • Describe concerns

  • Notes

Sign off

  • Verified by

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.