Title Page
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Date:
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Project:
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Client / Site
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Location
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Prepared by
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Personnel
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First Aider/s:
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Emergency Evacuation Point:
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Nearest Medical Facility / Hospital:
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Emergency Equipment Location:
PPE
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Site Specific Personal Protective Equipment (PPE) Required
- Hard Hat
- Hearing Protection
- Gloves
- Steel cap boots
- Hi--Vis vest
- Safety Glasses
- Respiratory aid
- Full Length shirts/pants
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Additional PPE:
Permits and Plant Equipment
Permits and Plans
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Confined Space Entry
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Working at Height
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Excavation and Drill
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Isolation
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Hot Work
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Environmental / Land Access
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Workbox
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Other:
Plant and Equipment
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Pre-start inspection completed on plant?
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Lifting gear inspected and tagged?
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Electrical gear tested and tagged?
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Plant risk assessed, inducted, and accepted?
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Climbing equipment (including ladders) inspected?
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Fall arrest equipment inspected?
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Safety detection (E.G Radman) equipment operational/calibrated?
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Other:
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Other:
Tasks
What are the tasks we are doing today?
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1.
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2.
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3.
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4.
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5.
Hazards
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Add a Hazards
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What are the key risk controls to be implemented?
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What are the key hazards?
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Who is responsible?
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Critical Risk?
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Note SHEWMS reference no.
Additional considerations
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Are there any other factors that can affect your work area (i.e. other work crews)? [Note Below]
Please list:
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Competencies
Competencies required to complete task (including verification of competency)
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Add Competencies
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Name:
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Competency:
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Ticket number:
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VOC Required?
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Upload evidence
Discussion
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Are there any incidents, injury concerns, hazard alerts, SHEQ alerts, directives, positive events/news, etc. that require discussing?
Add comment
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Specific Topics/issues raised:
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Add topic/issue:
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Topic / Issue:
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Comment or Action:
Emergency Plans:
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Emergency response plans communicated and well understood by all workers onsite?
Induction / Onboarding / Training / Competency:
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All workers have been on-boarded/inducted appropriately and are trained and competent to complete all tasks?
Changes to design/plans:
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Have changes to approved design / construction plans been assessed for risk and communicated to workers?
Weather forecast:
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Morning:
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Afternoon:
Pre-start Sign on
Pre-start Sign on
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I, the undersigned, hereby certify that I have been inducted to this job site by Visionstream or Site Supervisor, and that I have actively participated in the identification of hazards, assessment and control of risks associated with working at this location by way of this pre-start briefing. I agree to implement the control measures identified, including the use of the appropriate PPE:
Add person:
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Name and Signature:
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Company:
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Phone number:
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Start:
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Finish:
Authorising signature
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I certify that this form was completed prior to commencing work on this site, and that all workers and visitors have been inducted to site:
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Name and signature:
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Position:
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Date: