Title Page
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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?
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Conducted on
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Chaired By
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Location
Crew
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Crew Name
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Team Leader
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Supervisor
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First Aid Officer
Site
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Site Location (s)
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Emergency Evacuation point (if applicable)
Tasks for the day/project
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Tasks
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Has a JSEA been prepared for the above tasks? Have all on site (including contractors) reviewed and signed the JSEA?
Conversation
Communication
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What are the channels of communication on the site? Who needs to know?
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UHF Channel (if applicable)
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Traffic Control
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Trucks
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Plant
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Team Members
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Supervisor
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Comments (mandatory)
Resources
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What resources are being used today? Are there sufficient resources to complete the task(s) safely?
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Trucks
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Plant
Staff
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Appropriate personnel to complete the tasks safely?
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Fitness for work? (Fatigue, drugs/alcohol, injuries)
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Correct PPE
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Small Plant
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Comments (mandatory)
Services - overhead and underground
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Identified
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Details
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Dial Before You Dig
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Spotters
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Comments (mandatory)
Traffic Management
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Managed within the Team
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In-House Traffic Control
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External
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Traffic Control Company
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Traffic Management Plan details
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Plant and truck movements including exclusion zones
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Comments (mandatory)
Contractors
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Are any Contractors on site?
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Have all Contractors been inducted to site?
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Have all Contractors provided evidence of applicable licences and Safety Inductions?
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Have all Contractors reviewed and signed all applicable inductions and/or JSEAs?
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Comments (mandatory)
General Safety
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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.
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Discussion Items
- Working around Traffic (including site traffic)
- Weather Conditions
- Heat / Cold
- Manual Handling
- Bushfires
- Look out for each other
- Be alert at all times
- Personal Hygiene
- Social Distancing
- The Public
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Comments
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Have there been any recent Safety Events (across Council) that impact this worksite?
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What have we learnt from the recent event and how can we prevent it from happening on our worksite?
Signatures
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Positivity - a positive thought to kick start the day
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And remember - What are the Top 4 priorities in your life ......
All who attended to sign
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Signature
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Signature