Title Page
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Conducted on
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Prepared by
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Client
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Site
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CS&A Job Number :
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Date :
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Time :
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Weather Conditions:
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Survey Party Members :
- Shea Flanagan
- Nicholas Nightingale
- Brad Sanders
- Robert Spiby-Jones
- Seth Watson
- David O'Halloran
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Vehicle Registration:
- 1PD-2VJ (Orange)
- ZFL-542 (Green)
- ZFL-543 (Red)
- Other Vehicle (identify below)
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Other Vehicle Details (if Applicable):
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List the activities to be carried out :
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Survey Equipment / Instruments to be used:
- TS15
- TS16
- 1200
- 1100
- GPS
- Other; ie, Tape Measures, Disto, Levels, Digital Level
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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
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Other (unlisted) potential hazards :
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Related SWMS to potential hazards:
- 3.1 Bite and Sting Treatment
- 3.2 Computer Ergonomics
- 3.3 Manual Handling - Lifting
- 3.4 Remote Area 4 Wheel Driving
- 3.5 Traffic Management Roadside Construction Guideline
- 3.6 Vehicle Accident Procedure
- 3.7 Construction Surveys & Work Site Visits
- 3.7 Detail(Feature) Surveys
- 3.7 Hydrographic Surveys
- 3.7 Mining Surveys
- 3.7 Pipeline Surveys
- 3.7 Railway Surveys
- 3.7 Road Surveys
- 3.7 Subdivision Pegging
- 3.7 Survey at Heights
- 3.7 Underground Services
- 3.7 Watercourse Surveys
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Required PPE :
- Hardhat
- Protective boots
- Safety glasses
- Hi-vis clothing
- Broad-brimmed hat
- Long sleeves / long pants
- Gloves/Glove Clip
- Snake chaps
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Other (unlisted) required PPE :
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Required safety equipment :
- First-aid kit
- Traffic signs
- Flashing beacon
- 3rd party traffic management
- Spotter
- Confined space equipment
- Traffic Cones
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Other (unlisted) required safety equipment :
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Site Photos
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Party leader :
