DoT OHS Site Surveillance Checklist

• Contract No.

• Date and Time

  Date
• Location
  Address

• Contractor

  Select

• VicRoads Business Area

  Select

• Surveillance By

• Contractor Rep:

• OHS Representative

• Activity being undertaken

• Estimated daily traffic volume

  < 2000 vpd

  2000 vpd - 5000 vpd

  > 5000 vpd

• Clearance between workers and traffic

  < 1m

  1m- 2m

  3m - 5m

  5m - 10m

  > 10m

• Permanent Traffic Speed through area

  Select 40 50 60 70 80 90 100 110

  • 40
  • 50
  • 60
  • 70
  • 80
  • 90
  • 100
  • 110

• Worksite traffic speed

  Select 40 50 60 70 80 90 100 110

  • 40
  • 50
  • 60
  • 70
  • 80
  • 90
  • 100
  • 110

1. Safe Work Method Statements (SWMSs)

• 1.1(a) Pre-start daily site/project hazard analysis completed and appropriate controls conveyed to employees shift contractors and sub-contractors.

  Yes

  No

  N/A

• 1.1(b) Appropriate controls conveyed to employees shift contractors and sub-contractors (ie via toolbox meeting minutes or prestart meetings).

  Yes

  No

  N/A

• 1.2. Safe Work Method Statements reviewed to compliment Item 1.1

  Yes

  No

  N/A

• 1.3. I observed the following contractors/sub-contractors SWMS's being worked as stipulated:

Activities

• Activity

2. Training

• 2.1. Induction Training Records for shift contractors/sub-contractors sighted.

  Yes

  No

  N/A

• 2.2. Construction Induction Records for shift contractors/sub-contractors (red or white card)

  Yes

  No

  N/A

• 2.3. Safe Work Method Statements training records sighted for shift contractors/sub-contractors

  Yes

  No

  N/A

• 2.4. Competency training records sighted for shift contractors/sub-contractors.

  Yes

  No

  N/A

3. Site Safety (all items must be checked and recorded in accordance with the Project Surveillance Plan)

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

  Yes

  No

  N/A

• 3.2. Safe Operating Procedures on site.

  Yes

  No

  N/A

• 3.3. Are people on site following site safety rules?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 3.5. Personnel Protective Equipment and clothing used/worn.

  Yes

  No

  N/A

• 3.6. Plant speed restrictions/no go zones for pedestrians enforced.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 3.8. Corrective actions for accidents/WorkSafe notices/safety inspections/hazard reports implemented and working.

  Yes

  No

  N/A

• 3.9. Plant and equipment daily safety checks completed.

  Yes

  No

  N/A

• 3.10. Identified faults signed off as complete.

  Yes

  No

  N/A

• 3.11. Flashing lights/reversing cameras/proximity warning devices/reversing alarms operational.

  Yes

  No

  N/A

• 3.12. Communication systems in place for reversing plant.

  Yes

  No

  N/A

• 3.13. Dangerous Goods Register/MSDSs current

  Yes

  No

  N/A

• 3.14. Dangerous goods storage secure and signage displayed

  Yes

  No

  N/A

4. Worksite Traffic Management

Planning

• 4.1. Has a traffic management plan been selected or provided?

  Yes

  No

  N/A

• 4.2. Is the plan available for inspection?

  Yes

  No

  N/A

• 4.3. Is the plan relevant to the work?

  Yes

  No

  N/A

• 4.4. Is there a valid MOA?

  Yes

  No

  N/A

• 4.5. Are documented changes (if any) to the traffic management plan available for inspections?

  Yes

  No

  N/A

• 4.6. Have temporary roadworks speed limits been determined correctly? (Eg. Code of Practice for Worksite Safety - Traffic Management)

  Yes

  No

  N/A

Advance Warning / Signage

• 4.7. Are all roadworks signs and devices installed according to the traffic management plan?

  Yes

  No

  N/A

• 4.8. Have any contradictory, distracting or superfluous signs or markings been covered up or removed?

  Yes

  No

  N/A

• 4.9. Are signs appropriate for current conditions? (Eg. Symbolic worker signed not displayed/not visible when no workers on site, road condition signs after worksite vacated)

  Yes

  No

  N/A

• 4.10. Is signage suitably placed, especially for vehicles approaching at high speed? (Eg. Check sight distance, advance warning sign distance, height of signs above ground, vehicle queue length not beyond signage, check potential 'end of queue' issues)

  Yes

  No

  N/A

• 4.11. Are multi-message signs being used correctly?

  Yes

  No

  N/A

• 4.12. Are the signed free from damage and defect? (Eg. Easy to read, check shadow and glare issues).

  Yes

  No

  N/A

• 4.13. Are sign mountings secure, stable?

  Yes

  No

  N/A

• 4.14. Are signs in pairs where needed? (Note: recommended on high speed high volume roads and multi-lane roads).

  Yes

  No

  N/A

• 4.15. Are flashing arrows signs available and in use where required?

  Yes

  No

  N/A

• 4.16. Are sign sizes correct?

  Yes

  No

  N/A

Worksite

• 4.17. High visibility clothing appropriate for conditions and used and worn correctly? (Eg. Day/night, meet AS4602-1999 and AS1906.4-1997, clean, fastened, personnel visible)

  Yes

  No

  N/A

Work Zone Seperation

• 4.18. Are clearances between workers and adjacent traffic being maintained?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 4.20. Has containment fence been installed where required? (Eg. Workers/pedestrians/cyclists separation)

  Yes

  No

  N/A

Other Road Users

• 4.21. Are controls in place to minimise any congestion?

  Yes

  No

  N/A

• 4.22. Are the works impacting on public transport?

  No

  Yes

  N/a

• 4.23. Are pedestrians, cyclists and wheelchair access being catered for on site?

  Yes

  No

  N/A

• 4.24. Are side road and property access being impacted by the works?

  No

  Yes

  N/a

• 5. Comments, in particular any Project/Site Specific Issues not included on checklist eg. Site hazards detected during the course of the Contract, high risk construction work.