Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Lone Worker

  • Office notified and aware of return time

  • Mobile phone available

  • Other

Personal Protective Equipment

  • Hearing protection used

  • Safety boots used

  • Safety eye wear used

  • Hard hats worn

  • Safety vest worn and zipped up

  • Gloves used

  • Other

Manual Handling

  • Team lifting undertaken where applicable

  • Lifting equipment used

  • Manual Handling Training completed

  • Lightweight equipment used

  • Other

Dangerous Goods/Hazardous Substances

  • MSDS available and understood

  • SWMS relating to use prepared and understood

  • Safety eye wear worn

  • Half mask respirator worn

  • Gloves worn

  • Other

Environmental/Weather

  • Sunhat worn

  • Sunscreen

  • Sunglasses worn

  • Shelter from weather

  • Wet weather gear

  • Gumboots worn

  • Long sleeves worn

  • Other

Snakes/Spiders/Insects

  • Awareness of snakes/spiders/insects (refer to IRD-16, Guidelines for outdoor safety)

  • Gloves worn

  • Spider/insect repellent

  • Other

Traffic

  • Vehicle hazard lights

  • Witches hats

  • Safety vest worn

  • Parked in designated location/parking spot

  • Other

Public

  • Pedestrian warning signs

  • Site taped off

  • Other

Slips, Trips and Falls

  • Access to area via safest route, avoiding wet, muddy areas taken

  • Area kept clean and tidy

  • Other

Confined Space Associated

  • Permit

  • Permit number

  • Gas detector calibration expiry date

  • Call in process to OCC

  • Other

Plant & Equipment

  • Awareness of plant in vicinity

  • Tools & Equipment checked

  • Hard hats worn in vicinity of plant

  • Other

Other Works in Vicinity

  • Awareness of other works in vicinity which may have an impact

  • Contact made with others to ensure they are aware of you

  • Other

Electrical Cabinets

  • Understanding of what can and cannot be handled within

  • Call in process to OCC advising that access is required

  • Other

Fall from Heights

  • Barricades in position

  • Fall arrest harness used

  • Lad Safe system used

  • Lad Safe/harness system certified/current

  • Second person required

  • Gas detector used - opening wet well/MH

  • Fall protection device located in manhole

  • Other

Sign off

  • Are there other hazards?

  • If yes, what are they?

  • Is the job safe to proceed (if no, notify supervisor immediately)

  • Are all risks and controls communicated to attending personnel?

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  • Add signature

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  • Add signature

  • Notes

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