Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Type of work:

  • SR Number

  • On site:

  • Off site:

  • * Only answer questions that are relevant to the type of work being undertaken.

Job Safety Analysis

  • Is there a signed JSA on site?

  • Are the activities and controls noted on the JSA relevant to the site's works?

  • Are the controls and actions on the JSA in place?

Electrical

  • Are there any apparent Electrical OH&S issues on site?<br>Some common electrical checks:<br> - Electrical bridging leads<br> - Electrical leads tagged<br> - Mains power isolated<br> - Overhead power lines and are they protected

  • If yes, are these listed on the JSA?

Personal Protective Equipment

  • Are site personnel wearing appropriate PPE gear for the site works?

  • Is the PPE gear in a sound condition?

Other Underground Services

  • Have other underground services been identified?

  • Are site personnel aware of the other service location? (refer to JSA)

  • Have appropriate measures been taken to protect other services? (refer to JSA)

Excavation Works

  • Is the excavation over 1.5m in depth?

  • Has the excavation been shored?

  • Has the correct entry/exit means been provided in the excavation?

Hazardous Materials

  • Does the site have any hazardous materials?

  • Are there MSDS available on site?

  • Does the JSA refer to the hazardous materials?

  • Are the control measures in the JSA implemented?

  • Are the materials being contained in a safe manner?

Plant & Equipment

  • Is the relevant pant and equipment on site documented in the JSA?

  • Is theater and equipment being used in a safe manner?

  • Is the pant and equipment being used for e work it is designed for?

  • Is there any fluid release from the plant and equipment?

Manual Handling

  • Are personnel practicing correct manual handling skills?

Slips, Trips and Falls

  • Is the site kept in a neat and tidy state?

  • Are fall prevention measures in place? (refer to JSA)

  • Is equipment and materials stored safely?

Traffic Management

  • Is there. Traffic management plan?

  • Is the site set up to the traffic management plan?

  • Are pedestrians protected at all times?

  • Is work crew protected at all times?

Environment

  • Is there an environmental safety plan for these works?

  • Is the environmental plan being implemented?

Confined Space

  • Do these works involve confined space entry?

  • Does the JSA refer to confined space activity?

  • Are CWW's confined space procedures on site?

  • Are CWW's confined space procedures being implemented?

  • Notes/Comments

  • The purpose of this checklist is to assist CWW's Contract/Project Managers in meeting their OH&S responsibilities. The Checklist does not replace nor does it intend to replace audits undertaken by CWW's Audit group. If when using this checklist, the Contract/Project Manager becomes unsure of any site OH&S issue, they should immediately contact CWW's Audit group, or the OH&S Coordinator for advice.

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.