Title Page
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Contract or Project Name:
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Contract or Number / Ref:
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Name of Principle Supplier / Contractor:
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CoGG Contract Superintendent:
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Name of any Sub-Contractors:
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Date:
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Location
GENERAL SAFETY MANAGEMENT SYSTEM
OHS Structure and Systems (policy / procedures, Aims, commitment, etc.)
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On site copies of the Health and Safety Policy / Procedures including defined responsibilities.
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Photo of Evidence
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Reason for Non-conformance
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Non Conformance to be rectified by:
Safe Work Practices and Procedures (relevant to the contract)
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On site copies of the SWMS and relevant work instruction / procedures
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Photo of Evidence
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Reason for Non-conformance
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Non Conformance to be rectified by:
Incident Reporting and Investigation
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On site copy of a accident/incident form / book <br>On site copy of a Hazard reporting form
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Photo of Evidence
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Reason for Non-conformance
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Non Conformance to be rectified by:
Health and Safety Inspections
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On site copy of a checklist that is used for completing workplace inspections
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Photo of Evidence
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Reason for Non-conformance
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Non Conformance to be rectified by:
Health and Safety Consultation
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Copy of toolbox meeting minutes, diary notes of consultation activities, reviews to SWMS with sign-off by contractors employees.
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Photo of Evidence
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Reason for Non-conformance
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Non Conformance to be rectified by:
PLANT and EQUIPMENT
Inspections
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Mobile plant operation applicable to this site?
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Are daily plant operation checklists recorded?<br>Are maintenance records available for the equipment being used?<br><br>
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Photo of Evidence
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Reason for Non-conformance
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Non-Conformance to be rectified by:
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Do all operators of mobile plant hold a current and appropriate license?
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Photo of Evidence
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Reason for Non-conformance
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Non-Conformance to be rectified by:
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Confirm no mobile plant operating on site
Working under power-lines
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Working under power-lines applicable to this site?
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Has the SWMS identified this hazard?<br>Has Energy Safe Victoria been notified of the works?<br>Are all persons appropriately trained and are ‘spotters’ being used?<br><br>
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Photo of Evidence
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Reason for Non-conformance
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Non-Conformance to be rectified by:
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Confirm working under power-lines not applicable to this site
Traffic Management (as per AS1742.3)
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Is Traffic Management applicable to this site?
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Mobile plant is being used (e.g. Excavators, Elevated Work Platforms, Trucks, Deliveries) has a traffic management plan been developed, and is it reviewed daily when there is a change or if there is an incident?<br>
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Photo of Evidence
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Reason for Non-conformance
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Non-Conformance to be rectified by:
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Confirm Traffic Management plan not required
CHEMICALS
Systems of Work
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Are Chemicals being used on this site?
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Has a safe system of work been identified in the SWMS? Are the controls on the SWMS being implemented on the worksite?
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Photo of evidence
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Reason for Non-conformance
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Non-conformance to be rectified by:
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Are current MSDS available for ALL chemicals that are on the worksite?
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Photo of evidence
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Reason for Non-conformance
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Non-conformance to be rectified by:
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Are all chemicals stored appropriately and not decanted into unlabeled containers
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Photo of evidence
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Reason for Non-conformance
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Non-conformance to be rectified by:
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Confirm no Chemicals being used on site
MANUAL HANDLING
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Is Manual handling applicable to this worksite?
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Has Manual handling been identified in the SWMS?
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Photo of evidence
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Reason for non-conformance
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Non-conformance to be rectified by:
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Are manual handling controls being applied
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Photo of evidence
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Reason for Non-conformance
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Non-conformance to be rectified by:
PUBLIC SAFETY
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Is Public safety applicable to this worksite?
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Are warning signs in place? (i.e. on roads and/or footpaths)
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Photo of Evidence
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Reason for non-conformance?
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Non-conformance to be rectified by?
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Is the site adequately signed/fenced to prevent uncontrolled public access?
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Photo of Evidence
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Reason for non-conformance?
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Non-conformance to be rectified by?
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Can the site be controlled after hours?
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Photo of Evidence
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Reason for non-conformance?
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Non-conformance to be rectified by?
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Are all public surfaces (footpaths, roads etc) free from debris, work activities, stored materials, vehicles etc?
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Photo of Evidence
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Reason for non-conformance?
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Non-conformance to be rectified by?
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Is lighting suitable for night time public access?
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Photo of Evidence
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Reason for non-conformance?
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Non-conformance to be rectified by?
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Is safe pedestrian access to shops and residence maintained?
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Photo of Evidence
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Reason for non-conformance?
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Non-conformance to be rectified by?
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Have appriopriate notices advising of works been distributed to affected traders/residents?
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Photo of Evidence
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Reason for non-conformance?
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Non-conformance to be rectified by?
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Confirm public safety not applicable to this worksite
ELECTRICAL
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Photo of evidence
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Is electrical equipment being used on this site?
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Have safe systems of work been established within the SWMS?
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Photo of evidence
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Reason for Non-conformance
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Non-conformance to be rectified by?
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Are the controls on the SWMS being implemented on the worksite?
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Photo of evidence
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Reason for Non-conformance
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Non-conformance to be rectified by?
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Have all electrical items (power tools, extension cords, generators etc) been tested and tagged and is the test up to date?
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Photo of evidence
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Reason for Non-conformance
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Non-conformance to be rectified by?
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Confirm no electrical equipment is being used on site
OTHER
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Are other High risk activities associated with these works?
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Please outline other High risk activites
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Evidence of compliance
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Confirm no other high risk activities are to be performed as part of these works
