Contractor HSE Audit

1. COMPANY DETAILS - to be completed by Contractor

• Company Name:

• Site Address:
  Address

• Contact Name for Auditor to ask for on arrival:

• Phone Number:

• Email Address:

Is any special PPE required?

• Please state if these are available on site or if they need to be provided by the Auditor/s (the Auditor/s will have their own safety glasses and steel capped boots).

The Auditor will require access to one or more of areas in order to conduct the site audit component of the process. Please ensure that permission to access the site/premises is obtained from your client prior to the auditor's arrival.

• Please state where you will be conducting work on the date above:

• Office space is available for use by auditor during the Auditor preparation time?

  Yes

  No

  N/A

• Lunch can be obtained nearby?

  Yes

  No

  N/A

• A person will be available at all times to accompany the Auditor/s?

  Yes

  No

  N/A

• People required to be available during the day:
  1. Person conversant with the Safety & Environmental Management Systems/s of your company
  2. Supervision and field personnel as required throughout the day

2. AUDITORS DETAILS - to be completed by Fremantle Ports

• Auditors Name:

• Auditing Company:

• Audit Date:

  Date

• Service Order Number:

AUDITORS SUMMARY:

• Summary:

• Audit Type:

  Full Audit

  High Risk Action Plan Follow-Up

  Action Plan Follow-Up

  Surveillancce (First)

  Surveillane (Second)

• Recommendation:

• High Risk Action Plan due in:

  1 Month

  3 Months

• Due Date:

  Date

• Type:

  Yes

  No

  N/A

• Other Action plan due in:

  1 Month

  3 Months

• Due Date:

  Date

• Type:

  Physical

  Electronic

• Next Audit Type:

  Full Audit

  High Risk Action Plan Follow-Up

  Action Plan Follow-Up

  Surveillancce (First)

  Surveillane (Second)

• Due Date:

  Date

• IMPORTANT INFORMATION: Action Plans must be completed by the due date specified above. Should you have any questions and/or concerns upon receipt of your action plan, please contact us as soon as possible for discussion.
  
  For queries, please contact: Gerry O'Brien, Fremantle Ports Safety Coordinator gerry.o'brien@fremantleports.com.au 0477 114 115.

• Score System

  

• 1.1 Have all employees on this project completed pre-employment medical examinations?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.2 Have all employees on this project completed your company's induction?

  Yes

  No

  N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.3 Have all employees on this project completed the Fremantle Ports induction?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.4 Have all of your employees on this project been inducted into your Health and Safety Policy?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.5 Do all employees on this project understand their role and responsibilities?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.6 Are project HSE Management Plan / Bridging document hard copy / copies available for review by your employees?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.7 Are copies of your policies made visible for your employees and visitors?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.8 Project records managed and copies available?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.9 Acts and Regulations readily available?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.10 Are safe work procedures readily available, used and reviewed?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.11 Health & Safety hours and statistics recorded and forwarded to Fremantle Ports?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.12 Rewards and recognition program implemented?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.13 HSE communication - evidence of safety alerts/bulletins, actions displayed for work crew?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 1.14 Behavior base observations conducted?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 2.1 Are your employees on this project included on the company training matrix?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 2.2 Are your employees on this project scheduled to undertake skills enhancement?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 2.3 Are your employees training records available for this project on site and provided at clients request?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.1 Are your employees on this project competent / qualified to complete the tasks which they are required?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.2 Permit to work

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.3 Incident Reporting

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.4 Risk Management

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.5 Operation of EWP

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.6 Fire extinguishers

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.7 First aid

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.8 Height safety awareness

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.9 Manual handling

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.10 Preparation of reports

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.11 Trade qualifications

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person

• 3.12 Emergency response

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.13 Rigging

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.14 Crane dogman

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.15 Safety representative

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 3.16 Emergency response

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 4.1 Is your project chart displayed & do employees understand hierarchy of control/chain of command?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 4.2 Are your employees attending & participate in safety meetings and toolbox meetings? How are minutes of these meetings recorded and maintained?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 4.3 Is the project scope of work clearly outlined and understood by your Project Supervisors/Project Managers?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 4.4 Is the project scope of work being achieved?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 4.5 Are client representatives briefed on project requirements and progress?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 5.1 Does your company identify, assess, control & rate hazards?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 5.2 Does your company employees have access/availability to hazard register/matrix?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 5.3 Use of documented JHA's?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 5.4 Use of on site hazard identification documents?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 5.5 Use of "Step Back 5 x 5" prior /during after tasks?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 6.1 Are all issues & incidents reported, recorded and copies maintained?<br>- Near miss<br>- Personal injury/illness<br>- Equipment damage<br>- Equipment failure<br>- Fire<br>- Exposure<br>- Refusal to work<br>- Environmental

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 6.2 Are serious incidents investigated to establish root cause?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 6.3 Are recommendations for follow up action completed before management sign-off of incident reports?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 6.4 Have all incidents been immediately reported to client representative(s)?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 6.5 Do your employees understand the correct systems & procedures of issue/incident reporting?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 6.6 Are issue/incidents corrective actions reviewed & discussed with crews?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 6.7 Do you have an injury management & rehabilitation plan and procedures in place?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 7.1 Emergency response - have potential emergency scenarios been identified (e.g. fire, large spills etc.) and responses developed?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 7.2 Does your company have a planned and documented emergency response procedure?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 7.3 Are your employees aware and understand the correct procedures?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 7.4 Are client representatives briefed on emergency response procedures?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 7.5 Do your employees conduct emergency drills?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 8.1 Do you have a process for engaging sub contractors?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 8.2 Do your sub contractors provide a safety management plan prior to engagement?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 8.3 Are checks carried out by your organisation to ensure sub contractors have the required skills to conduct the work scope?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 8.4 Are sub contractors inducted into your organisation?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 8.5 Are sub contractors involved in your pre start and toolbox meetings?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 9.1 Are pre-start up checks conducted on equipment (i.e. plant, compressors & vehicles)?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 9.2 Are equipment checklists (pre-start and maintenance) being filled out correctly?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 9.3 Are records of "service of equipment" completed and maintained?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 9.4 Are personnel who undertake maintenance and servicing of equipment qualified/competent?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 9.5 Are tools and equipment correct for work scope?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 9.6 Are tools and equipment in good working order?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 9.7 Has all electrical tagging been completed and is it up to date?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 9.8 Are correct pressure hoses used for the task rated higher?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 9.9 Are hose restraint/whip checks fitted to high pressure hoses?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 10.1 Managers participate in HSE issues/incident investigations?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Yes

  No

  N/A

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 10.2 Managers conducted inspections, audits, walk?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Yes

  No

  N/A

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 10.3 Managers participate in HSE toolbox & pre-start meetings?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Yes

  No

  N/A

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 11.1 Is all critical safety equipment on a site register and up to date?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 11.2 Is appropriate PPR (harness, lanyards and inertia reels) maintained and available?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 11.3 Are any other forms of access equipment (i.e. ladders, scissor lifts, booms, cherry pickers etc.) used on this project? Are maintenance requirements as per Element 9 met for this equipment?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 12.1 Are your employees adhering to procedure/JAS when undertaking all operations:<br>- Hand tool<br>- Power tool (pressure cleaner)<br>- Drilling<br>- Manual handling<br>- Small motors<br>- Vehicle operations

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 12.2 Are work sites appropriately signed, so only authorised persons are allowed to enter?

  Yes

  No

  N/A

• Comments:

• Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 12.3 Are work sites appropriately barricaded to keep unauthorized persons from entering?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 12.4 Are all site roads access road maintained in a operational order?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 12.5 Approvals in place for road closures?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 12.6 Area identified/delineated for vehicle parking/reverse parking?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 12.7 Is appropriate PPE (gloves, eye protection, hearing protection, respiratory protection etc.) worn, maintained and available?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 12.8 Tool selected are suitable for the task and used correctly?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 12.9 Employees competent, qualified and confident in assigned task?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 12.10 Housekeeping - are project work sites, offices, compounds and storage facilities maintained in a tidy manner?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 13.1 Do you have a site register for all hazardous substances and up to date?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 13.2 Stored substances are adequately bunded, labeled and segregated?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 13.3 Chemicals approved and authorised by client?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 13.4 MSDS readily available to employees and in date?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 13.5 Emergency equipment readily available, e.g. fire extinguisher, spill kit.

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 14.1 Has all 'Classified Plant' been inspected by Fremantle Ports maintenance department

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 14.2 Are all vehicles & mobile plant on a register?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 14.3 All operators qualified & competent to operate equipment?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 14.4 Safe working loads marked on plant cab?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 14.5 Faults corrected immediately or actioned for close out.

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 14.6 Safety devices fitted & operational e.g. fire extinguishers, reverse beeper, guarding ,etc

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 15.1 Are employees actively & accurately monitoring and recording daily work

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 15.2 Does your company provide work completed documentation for client representatives?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 15.3 On this project are records maintained for:<br>- Environmental Monitoring?<br>- Employee Qualifications<br>- Equipment Checklists<br>- JHA’s<br>- Daily ,Weekly & Monthly report<br>- Site Inspection<br>- Vehicle inspections<br>- Daily Work Schedules<br>- Safety Workplace Inspections<br>- Timesheets<br>- Registers<br>- Other (specify)?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 16.1 Are site safety inspections conducted, documented & maintained by your company, employees working on this project?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 16.2 Are safety inspections improvements actioned & corrected in suitable time frame?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 16.3 Does client conduct workplace inspections & audits? Does your company complete in suitable time frame?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• Are internal / external audits required to be conducted on this project? Have these audits been scheduled? If yes, have they been conducted and recorded as per schedule?

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 17.1 Accreditation to perform rail works

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 17.2 Compliance requirements as per standard gauge code of practice for maintenance

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 17.3 Certification for works completed

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 17.4 Conformance to the regulations and requirements of the office of rail safety

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 17.5 Competencies and training records for employees to perform tasks associated with railways

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person:

• 17.6 Authorisation and certification to access and work on and in the vicinity of rail infrastructure

  Yes

  No

  N/A

• Comments:

• Score:

  Select 5 4 3 2 1 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • N/A

• Priority:

  Within 6 months

  Within 3 months

  By next audit

• Responsible Person:

  Senior Management

  Supervisors

  Other

• Responsible Person: