Title Page
-
Conducted on
-
Prepared by
-
Client / Site
-
Project :
-
CS&A Job Number :
-
Date :
-
Time :
-
Survey Party Members :
- Brad Sanders
- David O'Halloran
- Robert Spiby-Jones
- Nicholas Nightingale
- Tom Service
- Shea Flanagan
-
List the activities to be carried out :
-
Identify the potential hazards that could be encountered (select all that may be appropriate) :
- Vehicle accident
- Fall from height
- Slips and falls
- Open trench or shaft
- Construction plant
- Public traffic
- Construction traffic
- Rail traffic
- Wildlife (insects)
- Wildlife (reptile)
- Wildlife (other)
- Dangerous vegetation
- Exposure to elements
- Manual lifting
- Risk of drowning
- Contact with live power
- High fire risk
- Confined space
- Hostile owners / occupiers
-
Other (unlisted) potential hazards :
-
Required PPE :
- Hardhat
- Protective boots
- Safety glasses
- Hi-vis vest
- Broad-brimmed hat
- Long sleeves / long pants
- Gloves
- Snake chaps
-
Other (unlisted) required PPE :
-
Required safety equipment :
- First-aid kit
- Traffic signs
- Flashing beacon
- 3rd party traffic management
- Spotter
- Confined space equipment
-
Other (unlisted) required safety equipment :
-
Site Photos
-
Party leader :
