Information
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* Company Name
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* Work Site (Location)
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* Work Site (ESA)
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* Company Officer’s Name
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* Date of Inspection
Section 1
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SECTION 1. Project Manager or their representative is to complete this form.
Information
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Separable Portion
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Work Order Number
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Company’s Representative Name
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Company’s Representative Phone No (incl. Area Code)
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Company Officer’s Phone No (incl. Area Code)
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Company employee – Business unit & LOB (e.g. Network Construction / Wideband)
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Company employee - State
- NSW
- VIC
- QLD
- WA
- SA
- TAS
- NT
- ACT
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WBS / Network Number / Activity Number
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Brief Description of the Works
Special Qualifications for Inspection? Y - Yes N - No NA - Not Applicable
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Electrician
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Licence No.
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Registered Builder
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Licence No.
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Rigger / Dogman
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Licence No.
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Confined Spaces
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Licence No.
Inspection timing I - Initial, Inspection carried out on contractor commencing work for the company. D - During, Inspection carried out whilst contractor is working on site. C - Completion, Inspection carried out following practical completion.
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Please select one symbol below that can describe the timing of this inspecion
Section 2
Occupational Health & Safety P - Pass F - Fail NA - Not Applicable
Health and Safety Systems
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Site Induction records
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Workplace inspection records
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Emergency procedures
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Documented safe work procedures (JSA)
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Personal Protective Equipment including Gas detection and EME monitoring (e.g. Radman)
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Licences/competency records
Electrical
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Power tools in good condition
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Tools and leads inspected and tagged
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No cable trip hazards
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Lock-out procedures/danger tags in place
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Earth leakage systems used
Housekeeping
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Work areas free from rubbish & obstructions
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Free from slip/trip hazards
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Floor openings covered
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Stock/material stored safely
Mobile Plant and Equipment
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Plant and equipment in good condition
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Daily safety inspection procedures/checklists
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Operators trained
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Operators accredited / licensed
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Warning and instructions displayed
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WLL (or SWL) of lifting or carrying equipment displayed
Calibration
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Test gear used for final commissioning & acceptance within calibration
Prevention of Falls
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All work platforms have secure handrails, guarding or fence panels
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Harness and lanyard or belts provided
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All floor penetrations covered or barricaded
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Unsafe areas signposted and fenced
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Safe work procedures are in use
Hazardous Substances
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Stored appropriately
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Containers labelled correctly
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MSDS sheets
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Chemical register developed
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Appropriate emergency/first aid equipment-shower, eye bath, extinguishers
Ladders
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Ladders in good condition
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Ladders not used to support planks for working Platforms
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Correct angle to structure 1:4
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Extended 1.0 metre above top landing
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Ladders securely fixed at top
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Metal ladders not used near live exposed Electrical equipment
First Aid
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First aid kit on site & in date
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First aiders identified in induction
Section 2 cont.
Fire Control
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Fire fighting equipment serviced/tagged
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Emergency exit signage
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Exit doors easily opened from inside
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Exit pathways clear of obstruction
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Alarm/communication system-adequate
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Flammable storage procedures
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Emergency personnel identified
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Emergency telephone numbers displayed
Welding
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Gas bottles securely fixed to trolley
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Fire extinguisher near work area
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LPG bottles within 10 year stamp
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PPE provided and worn
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Hot Work permit system used
Excavations
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Excavation >1.5m deep is benched, battered or shored
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Shoring is stable
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Documented inspection of shoring system
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Angle of battering is sufficient to prevent collapse
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Excavated and other material or plant is > 1m from excavation edge
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Electrical hazards underground/overhead
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Excavation well secured
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Signage displayed
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Clear and safe access around excavation
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Separate access and egress points from excavation
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Safe work procedure in place
Confined Spaces
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Risk assessment undertaken
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Communication and rescue plan in place
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Safety equipment in good working condition
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Suitable training provided to employees
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Confined space permit used
Public Protection
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Appropriate barricades, fencing, hoarding, gantry, Secure in place
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Signage in place
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Suitable lighting for public access
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Footpaths clean and free from debris
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Dust and noise controls in place
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Site access controlled
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Traffic control procedures in place
Section 3
Quality Management P - Pass F - Fail NA - Not Applicable
Equipment Check
Rack
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Subrack
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Pigtail
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Cables (RF, Power, Alarm , Communications, Optic)
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Manholes
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Pits
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Trench/Plough/Directional Drilling
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
FAP
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
AC Distribution Board
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Battery
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Feeder
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Antenna
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Structure
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Shelter
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Other
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Labelled correctly?
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Constructed as per Work Order/Design Pack?
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Mounted/Installed Correctly?
Site / Compound (includes landscaping)
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Site access road serviceable
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Perimeter fence secure and in good condition
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Appropriate signage fitted
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Debris / Rubbish / Surplus material removed
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Landscaping/ screening not as per design / work order
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Reinstatement satisfactory
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Comments (Provide comments of standard of work etc)
Section 4
Environmental Management P - Pass F - Fail NA - Not Applicable
Vegetation & Weed Management
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Weed material removed and/or disposed of appropriately?
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Has machinery wash down been carried out in quarantine areas or as specified?
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Is the area to be cleared identified correctly and clearly marked?
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Is clearing and machinery access restricted to the assessed construction footprint?
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Has digging activities been carried out in a manner that minimises damage to limbs or roots system (i.e. outside the dripline)?
Heritage
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Is there adequate protection around identified heritage items or places (inc. Aboriginal sites)?
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Does the identified heritage item show any damage resulting from work activity?
Materials & Stockpiles
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Are materials and stockpiles stored away from trees?
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Are materials and stockpiles stored away from drainages or waterways?
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Are there appropriate protective and sedimentation controls?
Waste & Wastewater
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Is waste (esp. hazardous) and wastewater (e.g. from pits & during boring activity) being disposed of appropriately?
Soil Management
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Are erosion sediment controls implemented and operating effectively (e.g. gravel bags, diversion/check banks, sediment fences, sandbags)?
Working near/within/across waterways & water bodies
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Have approvals been gained and are appropriate measures in place to reduce sedimentation and pollution of the water?
Reinstatement
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Are trenches being compacted in layers, top soil relayed and the appropriate erosion controls in place (e.g. soil bunds, brush matting, silt fences, check dams)?
Other
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Is there evidence of spills?
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Have adequate controls been implemented in high fire risk areas?
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Have permit conditions been complied with (e.g. EPA, Council DA, noisy work, after hours work)?
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Does contractor have appropriately trained staff – are there records?
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Have there been any environmental incidents and have they been managed according to their procedure – are there incident reports?
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Have any audits/inspections been carried out on the environmental aspects of the project and are there audit/inspections reports?
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Have environmental assessments of site been undertaken and risks briefed to those entering site?
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Has the work caused serious / ongoing visual impact?
Section 5
Contract compliance
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Meets project timelines
- NA
- Unsatisfactory
- Marginal
- Acceptable
- Good
- Superior
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Contractor Employees’ conduct on site and appearance
- NA
- Unsatisfactory
- Marginal
- Acceptable
- Good
- Superior
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WINS procedure adhered to and documents available on site
- NA
- Unsatisfactory
- Marginal
- Acceptable
- Good
- Superior
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Management of Subcontractors
- NA
- Unsatisfactory
- Marginal
- Acceptable
- Good
- Superior
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Adherence to Quality systems
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Adherence to Safety systems
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Adherence to Environmental Systems
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General Comments (Provide comments of standard of work etc)
