Contractor Verification and Surveillance Checklist

• Document number

• Site

• Direct Control / Council or Contactor

• RMS

  Council

  Contractor

  Combined

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safety - Compliance to WHS Implementation & Site Compliance

• System to be used

  Yes

  No

  N/A

• S1 - Has a risk assessment been undertaken and documented? (Contractor included in EnSite for the Project and Ordered Works or Situation Awareness tool box for Routine Maintenance Works).

  Yes

  No

  N/A

• S2 - Is there documentary evidence that personnel have been inducted into the site specific risks, hazards and agreed controls?

  Yes

  No

  N/A

• S3 Are the required tickets of competencies recorded correctly and available for presentation on site eg general construction induction, WoF ticket, plant operator’s ticket or evidence of operator being deemed competent to operate plant items?

  Yes

  No

  N/A

• S4 - Are SWMS available for the activity being undertaken and the people involved in the activity signed off and or tool boxed in the SWMS?

  Yes

  No

  N/A

• S5 Are all contract personnel attending and contributing to daily tool box meetings? (Is there evidence of documented daily tool box talks with recording of attendees names)?

  Yes

  No

  N/A

• S6 - Is there a first aid officer & stocked first aid kit available?

  Yes

  No

  N/A

• S7 - Is housekeeping on site acceptable, in fire extinguisher and electrical equipment tagged for the current period?

  Yes

  No

  N/A

• S8- Are Safety Data Sheets (SDS) available? Have hazardous substances been identified and a hazardous substance register is on site?

  Yes

  No

  N/A

• S9 - Compliance with personal protective equipment (PPE)

  Yes

  No

  N/A

• S10 - Are daily plant pre-start inspections being complete?

  Yes

  No

  N/A

• S11 - Is heavy vehicle use in accordance with the contractor’s CoR (Speed, Fatigue, Mass, Dimension, Weight) controls?

  Yes

  No

  N/A

• S12 - Is there evidence of Weekly WHS inspections being complete?

  Yes

  No

  N/A

Environment - Environmental Requirements & Performance Behaviours

• System to be used

  Yes

  No

  N/A

• E1 - Has environmental risks been assessed and documented?

  Yes

  No

  N/A

• E2 - Are site specific environmental requirements known by the Contractor's personnel and documented?

  Yes

  No

  N/A

• E3 - Is the limit of works known by site personnel and protections put in place for No Go Zones?

  Yes

  No

  N/A

• E4 - Is housekeeping onsite acceptable, including the installation of effective erosion & sedimentation protection measures?

  Yes

  No

  N/A

• E5 - Are erosion & sediment controls checked as required? Are environmental inspections being completed as required?

  Yes

  No

  N/A

• E6 - Are wastes being recorded & managed correctly?

  Yes

  No

  N/A

• E7 - Are fuels and chemicals appropriately bunded?

  Yes

  No

  N/A

• E8 - Is wastewater being managed appropriately?

  Yes

  No

  N/A

• E9 - Is there evidence of equipment been regularly checked for defects? (oil spills,leaks, damaged hoses etc).

  Yes

  No

  N/A

• E10 - Do site personnel know the procedure for reporting of environmental incidents?

  Yes

  No

  N/A

• E11 - Is there a spill kit on site and have all personnel been trained in spill management?

  Yes

  No

  N/A

Quality - Quality Requirements & Performance Behaviours

• System to be used

  Yes

  No

  N/A

• Q1 - Does the contractor understand the requirements of the Specifications for the activity that they have been engaged to undertake?

  Yes

  No

  N/A

• Q2 - Are inspection and test plans being used and followed (MAP, Work Method Statement or Technical Procedure)?

  Yes

  No

  N/A

• Q3 - Is the inspection and status known ( including witness points and hold points submitted and signed off)?

  Yes

  No

  N/A

• Q4 - Are incoming products checked for compliance?

  Yes

  No

  N/A

• Q5 - Are work quantities recorded accurately?

  Yes

  No

  N/A

• Q6 - Has testing and survey been undertaken?

  Yes

  No

  N/A

• Q7 - Is rectification documented & work undertaken to achieve conformance?

  Yes

  No

  N/A

• Q8 - Are non conformances / nonconforming products identified and documented?

  Yes

  No

  N/A

• Q9 - Is a lot numbering system being used?

  Yes

  No

  N/A

• Q10 - Is monitoring & measuring equipment maintained and calibrated?

  Yes

  No

  N/A

Traffic - Traffic Management Requirements & Performance

• System to be used

  Yes

  No

  N/A

• T1 - Has a Traffic Control at work sites location Checklist been complete?

  Yes

  No

  N/A

• T2 - Is a standard TCP being used? …. (If Non- Standard TCP see T3)

  Safe

  At Risk

  N/A

• If Yes what is the TCP No:

• T3 - Has a site specific TCP been approved correctly and appropriate for the site conditions?

  Yes

  No

  N/A

• T4 - Has a VMP been approved and appropriate for the site?

  Yes

  No

  N/A

• T5 - Has a WoF plan been developed that is appropriate to to activity & has it been communicated to site personnel?

  Yes

  No

  N/A

• T6 - Are the needs of pedestrians and cyclists through the works considered?

  Yes

  No

  N/A

• T7 - Are Traffic control inspections records being completed accurately?

  Yes

  No

  N/A

• T8 - Are signs and devices clean, well maintained and installed in accordance with the TCP?

  Yes

  No

  N/A

• T9 - If required, is the ROL & SZA/DTR documentation in place with records kept? Are the requirements of the ROL known and being met?

  Yes

  No

  N/A

• T10 - Is there evidence that signs are covered when not in use? E.g. contradictory signs covered

  Yes

  No

  N/A

• Comments, Further Corrective Action :

Sign Off

• Site Representative Name

• Site Representative Signature

  Sign

• Surveillane Officers Name

• Surveillance Officers Signature

  Sign