Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Project and Client details
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Client
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Project
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Location
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Details
Site Inspection
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This checklist is to ensure that all hazards have been identified and where possible rectified prior to pour
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If "at risk" or "no" answered for any of the questions add photo or details of issue, if the issue has the potential to cause harm to workers do not commence pour until the issues have been rectified!
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Date and time of inspection
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Is there safe and clear access and egress to and from working deck
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General house keeping
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No obvious visible hazards that could potentially harm workers
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Mesh and other steel tied correctly to make sure no trips hazards are present
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Perimeter scaffolding / fall protection in place, (check whole perimeter to make sure no obvious gaps in fall protection and working deck)
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Penetrations covered so that no worker can fall through
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Extruding reo bars have bar caps so no worker can potentially harm them selfs on them
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No obvious visible electrical hazards that can potentially cause harm to workers
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Are appropriate exclusion zones set up by principal or other trades so that no worker can walk in an area which they could potentially get hurt
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Are emergency procedures in place by principal
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Any other visible hazards that are not listed above
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Any other visible hazards that are not listed above
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Any other visible hazards that are not listed above
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Any other visible hazards that are not listed above
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Any other visible hazards that are not listed above
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Details/Notes
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Sign off date
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CPS Supervisor sign off
Formwork sign off (suspended decks or decks with potential to give way and cause harm to workers only)
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To be signed off by principal's representative if this is not signed do not proceed with pour
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You confirm that the site/working deck formwork has been inspected and passed/signed off by an engineer or consultant, in accordance with AS3610 and you have received the appropriate documentation to confirm that the formwork has been installed correctly and is ready for concrete placement?
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Sign off date
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Principal representative sign off
Consultation with workers
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To be signed off by Supervisor!
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By signing this statement you are confirming that all hazards have been discussed with workers
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Statement sign off
