Title Page
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Customers Name
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Customer Address
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Inspection Date
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Prepared by
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Signature
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List types of service (multiple can be selected)
- REL
- FEL
- RO
- OTHER
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Please describe the type of service
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Bin/Container Size (multiple can be selected)
- 120L
- 240L
- 660L
- 1100L
- 1.5m
- 3.0M
- 4.5M
- 6.0M
- Other
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Photos of existing bins and location
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Padlocks Required
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Photos of existing bins and location
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Padlocks required
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Photos of existing bins and location
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Padlocks required
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Photos of existing bins and location
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Padlocks Required
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Bin Style
- Steel
- Plastic
- Slope Front
- Standard
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Photos of existing bins and location
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Padlocks required
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Bin Style
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Bin Lid
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Castors
- None
- LH Swivel
- RH Swivel
- All Swivel
- Lockable
- Not Lockable
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Photos of existing bin and location
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Padlocks required
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Bin Style
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Bin Lid
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Castors
- None
- LH Swivel
- RH Swivel
- All Swivel
- Lockable
- Not Lockable
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Photos of existing bin and location
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Padlocks required
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Bin Style
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Bin Lid
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Castors
- None
- LH Swivel
- RH Swivel
- All Swivel
- Lockable
- Not Lockable
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Photos of existing bin and location
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Description of the type of bin/s onsite (eg 23m Compactor, 30m Open Top RORO, 3m Skip, 30L Medical Sharps etc)
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Padlocks required
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Bin Style
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Bin Lid
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Castors
- None
- LH Swivel
- RH Swivel
- All Swivel
- Lockable
- Not Lockable
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Photos of existing bin and location
Is the driver exposed to any of the following hazards?
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Exert manual force to manoeuvre bins, lids,or other items
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Risk Level
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Please provide comments, Hazard details, To be added to Run Sheet
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Exposed to hazardous substances
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Risk Level
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Please provide comments, Hazard details, To be added to Run Sheet
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Exposed to dusty or noisy environment
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Risk Level
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Please provide comments, Hazard details, To be added to Run Sheet
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Unsafe or difficult access to bin for worker (upstairs, uneven ground)
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Risk Level
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Please provide comments, Hazard details, To be added to Run Sheet
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Please provide photos showing difficult access
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Inadequate ground surface condition or gradient
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Risk Level
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Please provide comments, Hazard details, To be added to Run Sheet
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Please provide photos showing ground surface
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Environmental impact from bin contents or location (near drains)
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Risk Level
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Please provide comments, Hazard details, To be added to Run Sheet
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Please provide photos showing proximity to drains
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Are emergency equipment and facilities obstructed by bin location (including man holes, underground services and fire protection services)
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Risk Type
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Please provide comments, Hazard details, To be added to Run Sheet
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Please provide photos showing obstruction due to bin placement
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Inadequate visibility and warning of pedestrians and other vehicle/traffic (consider proximity to walkways, building exits, other vehicles entering/exiting)
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Risk Type
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Please provide comments, Hazard details, To be added to Run Sheet
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Please provide photos showing proximity to pedestrian / vehicle traffic
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Unsafe & inappropriate access and egress to site for vehicle (reversing, turning, obstructions)
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Risk Type
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Please provide comments, Hazard details, To be added to Run Sheet
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Please provide photo showing access / egress for vehicle
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Insufficient space to service bin/obstructions (vehicle width, maneuverability, obstructed by parked cars, trees)
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Risk Type
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Please provide comments, Hazard details, To be added to Run Sheet
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Please provide photo showing available space
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Overhead obstruction in lifting zone eg wires, verandas, awnings. (must be a 3m minimum clearance between top of vehicle/equipment & power/comm lines)
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Risk Type
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Please provide comments, Hazard details, To be added to Run Sheet
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Please provide photo showing overhead obstructions
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Are there any other hazards (please describe)
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Risk Type
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Please provide comments, Hazard details, To be added to Run Sheet
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Please provide any photos
Site Risk Summary and Information
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What is the overall Risk Score for the site
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Is the driver required to be inducted onto the customers sire
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What additional PPE is required (eg: Hard Hat, Long Pants etc)
- Hi Vis
- Long Parts
- Hard Hat
- Safety Glasses
- Gloves
- Other
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Please describe other requirements
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Has the customer been advised of the waste types allowed in the bins?
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Are there any other requirements - Additional notes for drivers run sheet (eg access hours, time restrictions, deliveries, locks)
Proposed Bin Location
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Screen shot overhead view (Google Maps) and add bin location using annote function
Customer Acknowledgement & Agreement
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I agree to the positioning of the bin(s) as indicted . I understand that due to safety concerns , SUEZ may not service the bin(s) if not in the agreed service location and I may be charged for SUEZ's attendance at the site in accordance with the agreement in place between the parties. I acknowledge that I must consult with SUEZ if I wish to change the agreed service location of the bin(s)
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Name of customer representative
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Signature of customer representative
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Date of agreement
Site Manager / Supervisor review (all Critical or High scores)
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ADDITIONAL CORRECTIVE ACTIONS REQUIRED? JSEA/Risk Assessment. All 4.5m bins with castors must have an additional Risk Assessment/JSEA. Where reversing more than 20m onto a busy road/ near a bend. Site Manager must review this form for a potential alternative location or additional controls
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Form forwarded to customer service for keying
SUEZ Manager Review
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Site Manager Name
