Title Page
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Site conducted
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Date of Pre Site Assessment
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Assessment completed by
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Site Supervisor
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Job Address
SITE
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● Have three or more re-estab pegs been located?
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● Is there an electricity pit on either boundary or center of the block?
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● Are overheads clear of powerlines so as not to require an elec permit to work?
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● Has all tree protection requirements been put in place if applicable ?
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● Has the owner provided a clean and clear site ready for work?
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● Has all footpath & crossover damage been recorded and photographed?
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● Is all boundary fencing restricting access from neighbours and pedestrians?
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● Has perimeter fencing been photographed and documented for damage?
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● Has a traffic management plan been put in place? (If required)
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● Is an Dome Coordination plan sign clearly visible and filled in on front fence?
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● Is an Dome advertising sign clearly visible and filled in on front fence?
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● Has adequate toilet amenities been organised?
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● Is a retaining wall required?
COMPLETION
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Additional Comments
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Name and Signature