Title Page

  • The purpose of the form is to ensure everyone within the team understands the day's tasks and to promote discussion within the team on Safety.

Who and Where?

  • Conducted on

  • Chaired By

  • Location

Crew

  • Crew Name

  • Team Leader

  • Supervisor

  • First Aid Officer

Site

  • Site Location (s)

  • Emergency Evacuation point (if applicable)

Tasks for the day/project

  • Tasks

  • Has a JSEA been prepared for the above tasks? Have all on site (including contractors) reviewed and signed the JSEA?

Conversation

Communication

  • What are the channels of communication on the site? Who needs to know?

  • UHF Channel (if applicable)

  • Traffic Control

  • Trucks

  • Plant

  • Team Members

  • Supervisor

  • Comments (mandatory)

Resources

  • What resources are being used today? Are there sufficient resources to complete the task(s) safely?

  • Trucks

  • Plant

Staff

  • Appropriate personnel to complete the tasks safely?

  • Fitness for work? (Fatigue, drugs/alcohol, injuries)

  • Correct PPE

  • Small Plant

  • Comments (mandatory)

Services - overhead and underground

  • Identified

  • Details

  • Dial Before You Dig

  • Spotters

  • Comments (mandatory)

Traffic Management

  • Managed within the Team

  • In-House Traffic Control

  • External

  • Traffic Control Company

  • Traffic Management Plan details

  • Plant and truck movements including exclusion zones

  • Comments (mandatory)

Contractors

  • Are any Contractors on site?

  • Have all Contractors been inducted to site?

  • Have all Contractors provided evidence of applicable licences and Safety Inductions?

  • Have all Contractors reviewed and signed all applicable inductions and/or JSEAs?

  • Comments (mandatory)

General Safety

  • This section is designed to promote discussion on Safety factors that may impact on the day. Please select all from the list that apply and provide comments.

  • Discussion Items

  • Comments

  • Have there been any recent Safety Events (across Council) that impact this worksite?

  • What have we learnt from the recent event and how can we prevent it from happening on our worksite?

Signatures

  • Positivity - a positive thought to kick start the day

  • And remember - What are the Top 4 priorities in your life ......

All who attended to sign

    Signature
  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.