Title Page

  • Site conducted

  • Contract No

  • Conducted on

  • Prepared by

  • Location

DOT OH&S Checklist - Northern Region

  • Contract No

  • Item Number

  • Contractor

  • Surveillance By

  • Contract Site Manager

  • Activity being undertaken

  • Quality System Reference (Standard Section)

1. Safe Work Method Statements (SWMS,s)

  • 1.1 Pre - Start / project hazard analysis completed and appropriate controls conveyed to employees, contractors and sub contractors sighted.

  • 1.2 Safe Work Method Statements reviewed to compliment item 1.1

  • 1.3 Observed the following contractors / Sub contractors SWMS,s being used as stipulated (List comments in column)

2. Training

  • 2.1 Induction Training Records for contractors / Sub contractors sighted.

  • 2.2 Construction Induction Records for contractors / Sub contractors sighted (Induction Card)

  • 2.3 Competency training records sighted for contractors / Sub contractors.

  • 2.4 Tool Box Meeting minutes or Pre Start meetings sighted for Shift.

3. Site Safety

  • 3.1 Site amenities in accordance with Health and Safety Co-ordination Plan (eg: toilets - lunch room - water)

  • 3.2 OH&S policy displayed on site.

  • 3.3 Emergency procedures and emergency contact details for relevant authorities displayed on site.

  • 3.4 Safe Operating Procedures on site.

  • 3.5 Qualified first aiders on site.

  • 3.6 Are people on site following site safety rules.

  • 3.7 First aid kits are available on site, ensure stock list are available and have been checked.

  • 3.8 Permit to work documentation completed (power/gas/Telstra etc).

  • 3.9 Personnel Protective Equipment (PPE) and clothing used/warn

  • 3.10 Plant speed restrictions / No Go Zones for pedestrians enforced.

  • 3.11 Summary and records of accident / incident reports and investigations maintained on site.

  • 3.12 Corrective actions for accidents / WorkSafe Notices / Safety inspections / Hazard reports implemented and working.

  • 3.13 Plant and Equipment daily safety checks completed.

  • 3.14 Flashing lights / Reversing cameras / proximity warning devices / reversing alarms / communication systems operational.

  • 3.15 Are all items of plant registered or issued with unregistered vehicle permit as per the Road Safety Act (1986)

  • 3.16 Dangerous Goods Register / MSDS,s current.

  • 3.17 Dangerous Goods storage secure and signage displayed.

  • 3.18 Ensure appropriate fire extinguishers / equipment is on site. Check extinguishers for in date tag and are full.

  • 3.19 Is a qualified spotter required due to overhead powerlines?

  • 3.20 Who is the spotter ? Do they have current certificate / card / ticket.

4. Worksite Traffic Management - Planning

  • 4.1 Is there a approved traffic management plan available on site.

  • 4.2 Is there a valid Memorandum of Authorisation (MOA) on site.

  • 4.3 Has there been any changes to the approved traffic management plan. Are these documented.

  • 4.4 Is there a trained traffic controller on site, do they have current card / certificate / ticket.

Advance Warning / Signage

  • 4.4B Are all roadworks signs and devices installed according to the traffic management plan?

  • 4.5 Have any contradictory, distracting of superfluous signs or markings been covered up or removed?

  • 4.6 Are signs appropriate for current conditions?

  • 4.7 Is signage suitably placed, especially for vehicles approaching at high speed.

  • 4.8 Are multi message signs being used correctly?

  • 4.9 Are the signs free from damage and defects?

  • 4.10 Are signs securely mounted and stable?

Work Zone Separation

  • 4.11 Are clearances between workers and adjacent traffic being maintain?

  • 4.12 Are the safety barriers the same as depicted in the TMP and are no-go zones observed?

  • 4.13 Has containment fence been installed where required?

Other Road Users

  • 4.14 Has possible traffic congestion been consider and steps taken to avoid it?

  • 4.15 Have the effects of the works on public transport been considered.

  • 4.16 Have the needs of other road users been provided for (e.g. pedestrians, cyclists, wheelchairs)?

  • 4.17 Has proper access to side roads and properties been provided?

5. Other Comments

  • undefined

  • 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.