Title Page

  • Site conducted

  • PCBU

  • ACN/ABN:

  • Trading name

  • Principle Place of Business

  • Conducted on

  • Time of exit

ATTENDING INSPECTORS ASSESSMENT

PRIMARY CONTACT DETAILS

  • Primary Contact

  • Position

  • Phone

  • Email

  • OTHER CONTACT DETAILS
  • Name

  • Position

  • Phone

  • Email

COVID-19 Safety Plan

  • Do you have a COVID-19 Small Business Safety Plan in place?

  • Photos of COVID-19 Small Business Safety Plan:

INDUSTRY SPECIFIC ASSESSMENT

  • Industry sector associated with this inspection?

  • The following questions were asked of the Person Conducting Business or Undertaking (PCBU);

  • 1. Is PCBU supporting / facilitating work from home arrangements, where possible?

  • 2. Is the PCBU limiting access to the building site to essential workers involved in activity on the given day (limiting external visitors and or third parties)?

  • 3. Is the PCBU keeping and maintaining a daily log of worker movements to assist with contact tracing if required?

  • 4. Is the PCBU limiting physical interactions between workers, workers and clients, and workers and other persons at the site (i.e. contactless deliveries)?

  • 5. Does the PCBU limit the number of workers on site, where possible (i.e. splitting shifts or reducing the number of tasks to be completed each day)?

  • 6. Is the PCBU applying and enforcing the 1 person per 4 square metre rule on site?

  • 7. Has the PCBU created specific walkways through the construction site to maintain physical separation?

  • 8. Has the PCBU provided clear / designated work zones or areas for dedicated tasks?

  • 9. Has the PCBU scheduled sub-trades and work to minimise the number of people on site?

  • 10. Has the PCBU scheduled or implemented staggered start, finish, break and meal times for workers to limit the number of workers congregating in one area?

  • 11. Does the PCBU conduct toolbox discussions / meetings online, via telephone, in smaller groups or in a wide open space that enables workers to keep the required physical distance of at least 1.5 metres?

  • 12. Has the PCBU provided adequate amenities for personal hygiene and infection control?

  • 13. Have workers been instructed or directed to clean shared tools, plant and equipment immediately after use?

  • 14. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning plant and equipment?

  • 15. Has the PCBU increased cleaning and disinfection of high contact areas and frequently touched surfaces (i.e. lunch rooms, site offices, toilets, lifts, hoists, handrails and doors)?

  • 16. Does the PCBU conduct regular tool box discussions to enable workers to stay informed on risks and hazards including the latest Government COVID-19 updates?

  • 17. Has the PCBU placed reminders and cues (i.e. posters and signs) around the site to remind those within the workplace to maintain personal hygiene, cough and sneeze into a bent elbow and maintain social distancing, where reasonably practicable?

  • 18. Has the PCBU set maximum limits on the number of persons that can be in site offices and site sheds at the same time?

  • 19. Does the site have a hoist or lift?

  • 19a. Has the PCBU set a maximum limit on the number of persons that can use the hoist or lift at the same time?

  • 19b. Has the PCBU prohibited queuing or implemented floor markings that provide minimum guide distances between persons queuing?

  • The following questions were asked of the Person Conducting Business or Undertaking (PCBU);

  • 1. Has the PCBU provided amenities for personal hygiene and infection control?

  • 2. Is the PCBU supporting / facilitating work from home arrangements, where possible?

  • 3. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning counters, phones and computer equipment (i.e. keyboards)?

  • 4. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning play areas, toys and other childcare equipment?

  • 5. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. doors handles and high use areas)?

  • 6. Has the PCBU calculated the area of its floor space and set an upper limit on the number of persons (including workers, customers and others) who may be inside the workplace at any one time (based on one person per four square metres)?

  • 7. Has the PCBU placed reminders and cues (i.e. posters and signs) around the facility to remind those within the workplace to maintain personal hygiene, cough and sneeze into a bent elbow and maintain social distancing, where reasonably practicable?

  • 8. Has the PCBU, if practicable, introduced the use of floor markings or separate doors to avoid / minimise contact between persons entering and exiting the workplace?

  • 9. Has the PCBU, if practicable, introduced the use of hand washing facilities between persons entering and exiting the workplace and/ or hand sanitizer?

  • 10. Has the PCBU scheduled or implemented staggered start, finish, break and meal times for workers to limit the number of workers congregating in one area?

  • 11. Does the PCBU provide a break room for workers?

  • 11a. Has the PCBU considered staggering breaks?

  • 11.b Does the break room allow for social distancing?

  • The following questions were asked of the Person Conducting Business or Undertaking (PCBU);

  • 1. Has the PCBU provided amenities for personal hygiene and infection control?

  • 2. Is the PCBU supporting / facilitating work from home arrangements, where possible?

  • 3. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning the workspace (i.e. keyboards)?

  • 4. Has the PCBU updated procedures for the personal care of clients?

  • 5. Has the PCBU provided adequate PPE for the personal care of clients?

  • 6. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. doors handles and high use areas)?

  • 7. Has the PCBU calculated the area of its floor space and set an upper limit on the number of persons (including workers, customers and others) who may be inside the workplace at any one time (based on one person per four square metres)?

  • 8. Has the PCBU placed reminders and cues (i.e. posters and signs) around the facility to remind those within the workplace to maintain personal hygiene, cough and sneeze into a bent elbow and maintain social distancing, where reasonably practicable?

  • 9. Has the PCBU, if practicable, introduced the use of floor markings or separate doors to avoid / minimise contact between persons entering and exiting the workplace?

  • 10. Has the PCBU, if practicable, introduced the use of hand washing facilities between persons entering and exiting the workplace and/ or hand sanitizer?

  • 11. Does the PCBU provide a break room for workers?

  • 11a. Has the PCBU considered staggering breaks?

  • 11b. Does the break room allow for social distancing?

  • The following questions were asked of the Person Conducting Business or Undertaking (PCBU);

  • 1. Has the PCBU provided amenities for personal hygiene and infection control?

  • 2. Is the PCBU supporting / facilitating work from home arrangements, where possible?

  • 3. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning counters, phones and computer equipment?

  • 4. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning and sanitising equipment (i.e. scissors, shavers, capes and hairdryers)?

  • 5. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. high use areas, client seats and door handles)?

  • 6. Has the PCBU introduced a staggered booking system to minimise crossover of clients?

  • 7. Has the PCBU calculated the area of its floor space and set an upper limit on the number of persons (including workers, customers and others) who may be inside the workplace at any one time (based on one person per four square metres)?

  • 8. Has the PCBU placed reminders and cues (i.e. posters and signs) around the facility to remind those within the workplace to maintain personal hygiene, cough and sneeze into a bent elbow and maintain social distancing, where reasonably practicable?

  • 9. Has the PCBU, if practicable, introduced the use of floor markings or vacant chair to avoid / minimise contact between clients and staff?

  • 10. Has the PCBU, if practicable, introduced the use of hand washing facilities between persons entering and exiting the workplace and/ or hand sanitizer?

  • 11. Does the PCBU provide a break room for workers?

  • 11.a Does the break room allow for social distancing?

  • 11b. Has the PCBU considered staggering breaks?

  • The following questions were asked of the Person Conducting Business or Undertaking (PCBU);

  • 1. Is the PCBU supporting / facilitating work from home arrangements, where possible?

  • 2. Has the PCBU provided amenities for personal hygiene and infection control?

  • 3. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning counters, tills, phones, computer equipment (i.e. keyboards) and eftpos facilities?

  • 4. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. doors, handles, point of sale devices, counters, displays, kiosks, trolleys, baskets, lifts)?

  • 5. Has the PCBU placed reminders and cues (i.e. posters and signs) around the store to remind those within the workplace to maintain personal hygiene, cough and sneeze into a bent elbow and maintain social distancing, where reasonably practicable?

  • 6. Has the PCBU calculated the area of its retail floor space and set an upper limit on the number of persons (including workers, customers and others) who may be inside the workplace at anyone time (based on one person per four square metres)?

  • 7. Has the PCBU implemented floor markings that provide minimum guide distances between queuing customers?

  • 8. Has the PCBU, if practicable, introduced the use of floor markings or separate doors to avoid / minimise contact between persons entering and exiting the workplace?

  • 9. Is the PCBU, where possible, rotating tasks to ensure that no one worker has all the contact with customers?

  • 10. Is the PCBU encouraging cashless transactions to reduce contact?

  • 11. Is the PCBU is set up for online trade?

  • 11a. Is the PCBU promoting its online trading and encouraging customers to use the online service over the face to face service in store?

  • 12. Does the PCBU provide a break room for workers?

  • 12a. Has the PCBU considered staggering breaks?

  • 12b. Does the break room allow for social distancing?

  • The following questions were asked of the Person Conducting Business or Undertaking (PCBU);

  • 1. Has the PCBU provided amenities for personal hygiene and infection control?

  • 2. Is the PCBU supporting / facilitating work from home arrangements, where possible?

  • 3. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning counters, phones and computer equipment (i.e. keyboards)?

  • 4. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning the vehicles before driver change over?

  • 5. Has the PCBU allocated specific vehicles to drivers?

  • 6. Has the PCBU implemented contactless delivery options?

  • 7. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. doors handles and high use areas)?

  • 8. Has the PCBU calculated the area of its floor space and set an upper limit on the number of persons (including workers, customers and others) who may be inside the workplace at any one time (based on one person per four square metres)?

  • 9. Has the PCBU placed reminders and cues (i.e. posters and signs) around the facility to remind those within the workplace to maintain personal hygiene, cough and sneeze into a bent elbow and maintain social distancing, where reasonably practicable?

  • 10. Has the PCBU, if practicable, introduced the use of floor markings or separate doors to avoid / minimise contact between persons entering and exiting the workplace?

  • 11. Has the PCBU, if practicable, introduced the use of hand washing facilities between persons entering and exiting the workplace and/ or hand sanitizer?

  • 12. Does the PCBU provide a break room for workers?

  • 12a. Does the break room allow for social distancing?

  • 12b. Has the PCBU considered staggering breaks?

  • The following questions were asked of the Person Conducting Business or Undertaking (PCBU);

  • 1. Has the Cafe / Restaurant limited seating to allowable levels?

  • 2. Has the PCBU provided amenities for personal hygiene and infection control?

  • 3. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning counters, phones and computer equipment (i.e. keyboards)?

  • 4. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. doors, handles, point of sale devices, counters, displays, kiosks, trolleys, baskets, lifts)?

  • 5. Has the PCBU placed reminders and cues (i.e. posters and signs) around the store to remind those within the workplace to maintain personal hygiene, cough and sneeze into a bent elbow and maintain social distancing, where reasonably practicable?

  • 6. Has the PCBU taken steps to minimise face to face contact with patrons?

  • 7. Has the PCBU placed signage to advise of maximum numbers allowed in the cafe / restaurant?

  • 8. Has the PCBU implemented floor markings that provide minimum guide distances between queuing customers?

  • 9. Has the PCBU, if practicable, introduced the use of floor markings or separate doors to avoid / minimise contact between persons entering and exiting the workplace?

  • 10. Is the PCBU, where possible, rotating tasks to ensure that no one worker has all the contact with customers?

  • 11. Is the PCBU encouraging cashless transactions to reduce contact?

  • 12. Is the PCBU set up for online trade?

  • 12a. Is the PCBU promoting its online trading and encouraging customers to use the online service over the face to face service in store?

  • 13. Does the PCBU provide a break room for workers?

  • 13a. Does the break room allow for social distancing?

  • 13b. Has the PCBU considered staggering breaks?

  • 1. Has the PCBU provided amenities for personal hygiene and infection control?

  • 2. Is the PCBU supporting / facilitating work from home arrangements, where possible?

  • 3. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning counters, phones and computer equipment (i.e. keyboards)?

  • 4. Has the PCBU created a register for those attending open homes?

  • 5. Has the PCBU limited open homes and auctions to 10 people (including staff)?

  • 6. Has the PCBU arranged for additional cleaning of homes for inspection?

  • 7. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. doors handles and high use areas)?

  • 8. Has the PCBU calculated the area of its floor space and set an upper limit on the number of persons (including workers, customers and others) who may be inside the workplace at any one time (based on one person per four square metres)?

  • 9. Has the PCBU placed reminders and cues (i.e. posters and signs) around the facility to remind those within the workplace to maintain personal hygiene, cough and sneeze into a bent elbow and maintain social distancing, where reasonably practicable?

  • 10. Has the PCBU, if practicable, introduced the use of floor markings or separate doors to avoid / minimise contact between persons entering and exiting the workplace?

  • 11. Has the PCBU, if practicable, introduced the use of hand washing facilities for persons entering and exiting the workplace and/ or hand sanitizer?

  • 12. Does the PCBU provide a break room for workers?

  • a) If yes to question 12, does the break room allow for social distancing?

  • b) If no to question 12, has the PCBU considered staggering breaks?

  • 1. Has the PCBU provided amenities for personal hygiene and infection control?

  • 2. Has the PCBU reduced/removed the use of cash payments?

  • 3. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning counters, phones and computer equipment (i.e. keyboards)?

  • 4. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning the vehicles before driver change over?

  • 5. Has the PCBU allocated specific vehicles to drivers?

  • 6. Has the PCBU implemented social distancing on seats?

  • 7. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. doors handles and high use areas)?

  • 8. Has the PCBU calculated the area of its floor space and set an upper limit on the number of persons (including workers, customers and others) who may be inside the vehicle at any one time?

  • 9. Has the PCBU placed reminders and cues (i.e. posters and signs) when entering the vehicle to remind those traveling to maintain personal hygiene, cough and sneeze into a bent elbow and maintain social distancing, where reasonably practicable?

  • 10. Has the PCBU, if practicable, provided a screen for the driver?

  • 11. Has the PCBU, if practicable, introduced the use of hand washing facilities for persons entering and exiting the vehicle and/ or hand sanitizer?

  • 12. Does the PCBU provide a break room for workers?

  • a) If yes to question 12, does the break room allow for social distancing?

  • 1. Has the PCBU provided amenities for personal hygiene and infection control?

  • 2. Is the PCBU supporting / facilitating work from home arrangements, where possible?

  • 3. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning counters, phones and computer equipment (i.e. keyboards)?

  • 4. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning industrial equipment, plant and other warehousing equipment?

  • 5. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. doors handles, crib rooms and high use areas)?

  • 6. Has the PCBU calculated the area of its floor space and set an upper limit on the number of persons (including workers, customers and others) who may be inside the workplace at any one time (based on one person per four square metres)?

  • 7. Has the PCBU placed reminders and cues (i.e. posters and signs) around the facility to remind those within the workplace to maintain personal hygiene, cough and sneeze into a bent elbow and maintain social distancing, where reasonably practicable?

  • 8. Has the PCBU, if practicable, introduced the use of floor markings or separate doors to avoid / minimise contact between persons entering and exiting the workplace?

  • 9. Has the PCBU, if practicable, introduced the use of hand washing facilities between persons entering and exiting the workplace and/ or hand sanitizer?

  • 10. Does the PCBU provide a break room for workers?

  • a) If yes to question 12, does the break room allow for social distancing?

  • b) If no to question 12, has the PCBU considered staggering breaks?

  • 1. Has the PCBU provided adequate amenities for personal hygiene and infection control?

  • 2. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning and sanitising equipment, tools and facilities?

  • 3. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. doors, handles, lunchrooms, smoking areas and bathrooms)?

  • 4. Has the PCBU placed reminders and cues (i.e. posters and signs) around the packing shed and lunchroom to remind those within the workplace to maintain personal hygiene, cough and sneeze into a bent elbow and maintain social distancing, where reasonably practicable?

  • 5. Where social distancing is not possible, has the PCBU split the workforce into identifiable teams And segregated teams by time or space based on close-contact likelihood?

  • 6. Has the PCBU set maximum limits on the number of persons that can be in site offices and packing sheds at the same time (based on one person per four square metres)?

  • 7. Does the PCBU limit the number of workers on site, where possible (i.e. splitting shifts or reducing the number of tasks to be completed each day)?

  • 8. Has the PCBU, if practicable, staggered or increased time between shifts to minimise unnecessary interactions between workgroups?

  • 9. Does the PCBU provide a break room for workers?

  • Has the PCBU considered staggering breaks?

  • Does the break room allow for social distancing?

  • 10. Is the PCBU keeping and maintaining a daily log of worker movements to assist with contact tracing if required?

  • 11. Does the PCBU conduct toolbox discussions / meetings online, via telephone, in smaller groups or in a wide open space that enables workers to keep the required physical distance of at least 1.5 metres?

  • 12. Does the PCBU provide transport to site?

  • Are they limiting numbers on the method of transport?

  • 13. Does the PCBU provide accommodation?

  • Have they implemented additional cleaning?

  • Have they limited the number of people living in the accommodation?

  • 1. Has the PCBU restricted services to booked appointments only?

  • 2. Has the PCBU implemented a pre appointment checklist?

  • 3. Has the PCBU provided amenities for personal hygiene and infection control for staff?

  • 4. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning counters, tills, phones, computer equipment (i.e. keyboards) and eftpos facilities?

  • 5. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. doors, handles, point of sale devices, counters, displays, kiosks, trolleys, baskets, lifts)?

  • 6. Has the PCBU placed reminders and cues (i.e. posters and signs) around the salon to remind those within the workplace to maintain personal hygiene & social distancing, where reasonably practicable?

  • 7. Have the PCBU and all staff completed the COVID online training?

  • 8. Is the PCBU ensuring all patrons wash and/or sanitise hands before treatment?

  • 9. Has the PCBU implemented floor markings that provide minimum guide distances between queuing customers?

  • 10. Has the PCBU, if practicable, introduced the use of floor markings or separate doors to avoid / minimise contact between persons entering and exiting the workplace?

  • 11. Is the PCBU, where possible, rotating tasks to ensure that no one worker has all the contact with customers?

  • 12. Has the PCBU implemented single use items?

  • • Where they haven’t can items be sterilised between clients?

  • 13. Does the PCBU provide a break room for workers?

  • • If yes to question 12, does the break room allow for social distancing?

  • • If no to question 12, has the PCBU considered staggering breaks?

  • 14. Is the PCBU maintaining a contact tracing register for a minimum of 21 days?

  • 15. Has the PCBU banned clients from bringing in shopping bags from other stores?

  • 16. Has the PCBU installed screens for nail technicians?

  • • If no have they provided face masks?

  • 1. Is the gym limited to no more than 20 patrons at one time?

  • 2. Is there a staff member rostered to be on site at all times during opening hours?

  • 3. Has the PCBU provided amenities for personal hygiene and infection control for staff?

  • 4. Has the PCBU provided cleaning products, instruction and any appropriate PPE for cleaning counters, tills, phones, computer equipment (i.e. keyboards) and eftpos facilities?

  • 5. Has the PCBU increased cleaning and disinfection of high contact areas and surfaces (i.e. doors, handles, point of sale devices, counters, displays, kiosks, trolleys, baskets, lifts)?

  • 6. Has the PCBU placed reminders and cues (i.e. posters and signs) around the gym to remind those within the workplace to maintain personal hygiene & social distancing, where reasonably practicable?

  • 7. Has the PCBU closed toilets, shower and change room facilities?

  • 8. Has the PCBU implemented floor markings that provide minimum guide distances between queuing customers?

  • 9. Has the PCBU, if practicable, introduced the use of floor markings or separate doors to avoid / minimise contact between persons entering and exiting the workplace?

  • 10. Is the PCBU, where possible, rotating tasks to ensure that no one worker has all the contact with customers?

  • 11. Has the PCBU provided cleaning supplies for patrons?

  • • Is there instructions for how to use?

  • 12. Are patrons required to have a towel to wipe down equipment?

  • 13. Has the PCBU removed items like foam rollers, bands and other equipment that can’t be cleaned easily?

  • 14. Does the PCBU provide a break room for workers?

  • • If yes to question 12, does the break room allow for social distancing?

  • • If no to question 12, has the PCBU considered staggering breaks?

  • 15. Is the PCBU maintaining a contact tracing register for a minimum of 21 days?

ADDITIONAL CONTROL MEASURES ESTABLISHED BY PCBU

  • undefined

INSPECTOR’S OBSERVATIONS

  • Inspector observations:

  • Observation photos:

RISK OF WORKPLACE EXPOSURE

  • undefined

ACTION TAKEN BY INSPECTOR

  • Provided education / guidance material

  • Actions taken by inspector as described above in the response to each question

SITE ATTENDANCE DETAILS

  • Inspector

  • Time Inspection Completed

Disclaimer

  • DISCLAIMER
    This report only deals with matters the subject of the specific inspection. It does not purport to indicate overall
    compliance status of the relevant duty holder(s) with work health and safety laws.
    INTERNAL REVIEW OF CERTAIN INSPECTOR DECISIONS
    You are able to apply for internal review of a decision made by an inspector during this visit. Information on how
    to seek an internal review is available on our website: www.worksafe.tas.gov.au

    FEEDBACK
    If you want to clarify any matter that is covered by the Inspection Report and any associated Notices or
    Directions, please contact the issuing Inspector, whose name and contact details appear at the top of this
    Inspection Report.
    If you want to provide feedback about any aspect of how this inspection was conducted, please lodge a
    complaint through our website at www.worksafe.tas.gov.au

    PERSONAL INFORMATION PROTECTION
    Personal information we collect from you will be used by WorkSafe Tasmania for that purpose and may be used
    for other purposes permitted by legislation and policies administered by WorkSafe Tasmania or WorkCover
    Tasmania. Your personal information may be disclosed to contractors and agents of WorkSafe Tasmania,
    WorkCover Tasmania, law enforcement agencies, courts and other public sector bodies or organisations
    authorised to collect it. This information will be managed in accordance with the Personal Information
    Protection Act 2004 and may be accessed by you on request to this Department.

    FURTHER INFORMATION
    WorkSafe Tasmania has a range of publications to explain your legal responsibilities and help you make your
    premises/site safer. To inquire about these publications, telephone 1300 366 322 (inside Tasmania) or (03) 6166
    4600 (outside Tasmania) or visit our website www.worksafe.tas.gov.au.

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.