Title Page
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Work Activity
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Workplace/Location
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Conducted on
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Verifier (Name) and Signature
Verification Criteria
1. Exclusion and No-Go Zones are planned and communicated:
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a) Communicated to the workforce daily via prestarts and/or Vehicle Movement Plans?
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b) Physical barriers and/or visual delineation devices are used where practical?
2. Unauthorised workers of foot do not enter exclusion or no go zones:
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a) Spotters actively control operating zone access and not performing simultaneous operations
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b) Positive communication protocols are used by plant operators, spotters and workers on foot to control operating zones?
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c) There are no recorded breaches of exclusion and non go zones?
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d) Plant and vehicle spotters are trained to Downer level 1 within past 24 months?
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e) Two way radio are provided to plant operators, spotters and worker on foot?
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f) Spotters and workers on foot are identified by distinctive high visibility PPE?
3. Protection from live road and construction traffic
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a) Full or partial road closures are in place?
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b) Speed restrictions and physical separation from live traffic match site conditions? <1.2m 40kmph; >1.2m - <3m 60kmph; hard barrier, no speed reduction
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c) TMP is implemented as per plan?
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d) TMP inspections are conducted?
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e) Local residents have been notified of traffic changes and controls
4. Site vehicle and plant movements are planned to eliminate all but unavoidable reversing
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a) Vehicle movement plans clearly show direction of travel, parking, loading and reversing areas?
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b) Spotters are assigned and actively control unavoidable reversing?
5. Construction vehicle and plant safety devices:
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a) Reversing alarms are fitted to all construction vehicles and plant?
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b) Reversing cameras are fitted where specified?
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c) Daily pre-start checks confirm all safety devices are functioning?
6. Recovery controls are:
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a) Available on site through trained first aiders and first aid supplies?
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b) Communicated through notice boards and inductions?
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c) Practice through emergency response drills?
Critical Control Effectiveness
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Indicate the overall level of effectiveness of the Critical Control