DoT Take 5 - Site Visit & Inspection

• Site conducted

  Select

• Document No.

• Prepared by

• Conducted on

  Date
• Location
  Address

• Location Description

• Task

1. STOP! LOOK AROUND THE WORKSITE

• Observe the work area and surrounds for risks / hazards. Look Close, Look Above, Look Below, Look Wide and Look for Hidden Hazards

2. STOP! THINK THROUGH THE TASK / WORKS

• 1. Have you signed onto the current SWMS Site Visits & Inspections?

  Yes

  No

  N/A

• STOP! Talk to your supervisor / manager

  

• Yes

  No

  N/A

• 2. Is a copy of the SWMS with you?

  Yes

  No

  N/A

• STOP! Talk to your supervisor / manager

  

• 3. Is there adequate space away from live traffic for parking?

  Yes

  No

  N/A

• STOP! Talk to your supervisor / manager

  

• 4. Does your vehicle have yellow flashing lights on the roof?

  Yes

  No

  N/A

• STOP! Talk to your supervisor / manager

  

• 5. Have you communicated your attendance to site with the site supervisor?

  Yes

  No

  N/A

• STOP! Talk to your supervisor / manager

  

• 6. Do you have the required skills, training, licences and permits for the task?

  Yes

  No

  N/A

• STOP! Talk to your supervisor / manager

  

• 7. If applicable, have you signed into the site visitors register and induction?

  Yes

  No

  N/A

• STOP! Talk to your supervisor / manager

  

• 8. Is any equipment or tools being used suitable to the task and in good order?

  Yes

  No

  N/A

• STOP! Talk to your supervisor / manager

  

• 9. Do you have all the appropriate PPE? Is it in good condition?

  Yes

  No

  N/A

• STOP! Talk to your supervisor / manager

  

• PPE includes but is not limited to High Visibility Clothing, Safety Vest, Sunscreen, Broad Rim Hat, Safety Shoes, Safety Glasses, Gloves, Hard Hat, Hearing Protection, Face Shield, Long Pants, Long Sleeves, Dust Mask and Snake Gators along with other task / site specific PPE

• 10. Do you have an agreed form of communication for the task/works?

  Yes

  No

  N/A

• STOP! Talk to your supervisor / manager

  

• 11. Do you have a clear plan & job steps in mind?

  Yes

  No

  N/A

• STOP! Talk to your supervisor / manager

  

• Add media

  Media

3. LOOK FOR RISKS / HAZARDS (If Risk / Hazard is not applicable to site, select N/A)

• A. Is live traffic presenting a risk to undertaking the task?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• B. Is there greater than 15 vehicles in a minute?

  Yes

  No

  N/A

• Do I have a buddy/spotter?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• C. Is sight distance less than 250m or 10 seconds to oncoming traffic?

  Yes

  No

  N/A

• Do I have a buddy/spotter?

  Yes

  No

  N/A

• Do you need a spotter?

  Yes

  No

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• D. Are there vehicles or plant reversing?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• E. Is there a risk of falling from heights?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• F. Are there overhead services?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• G. Are there any overhanging trees over the work area?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• H. Are there any confined spaces involved?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• I. Do you have to climb ladders or steps?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• J. Could I slip, trip or fall?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• K. Can I be caught in, on or between anything?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• L. Could something fall and strike me?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• M. Could something injure my hands, affect my hearing or my eyes ?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• N. Will the task take longer than 20 minutes?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• O. Am I working alone?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• P. Could I strain or over exert myself?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• Q. Could I come in contact with something that may harm me (electricity, chemicals, heat, gas, fumes, pressurised pipes, etc.)?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

• R. Are there animals / insects that could harm me (Snakes, ticks, leeches, mosquitos)?

  Yes

  No

  N/A

• Are there any Controls in Place?

  Yes

  No

  N/A

• Please list the control measures implemented if not covered by SWMS.

• STOP! Do not proceed, talk to your supervisor / manager.

  

4. LOCAL CONDITIONS

• Is the area a mobile phone dead spot for coverage? (If so, have i notified someone of my planned whereabouts?)

  Yes

  No

  N/A

• Is it a CODE RED Day (should avoid Site Visits) or a Total Fire Ban Day?

  Yes

  No

  N/A

• Other Climatic conditions to be aware of (eg. snow, black ice, fog, sun glare, high winds, extreme temperatures, dawn, dusk, smoke, flood water)?

  Yes

  No

  N/A

5. COMMUNICATE AND CONTROL HAZARDS

• Have I communicated the hazards & risks associated with this task and the controls implemented to other workers attending this site? (List names in next section if applicable)

  Yes

  No

  N/A

• STOP! Communicate the hazards and risks associated with this task and the controls implemented to the other workers attending this site.

  

• Have I controlled all the risks / hazards so the task can proceed safely?

  Yes

  No

• STOP! Talk to your supervisor, enter the hazard and control measures above and below.

  

• DOES THIS FEEL RIGHT?

  Yes

  No

• STOP! Talk to your supervisor

  

6. DO THE JOB SAFELY Note: If the task or site conditions change that could impact on safety, STOP and this Take 5 is re-completed.

• List identified Hazards and respective Controls if not covered by SWMS

• Additional Comments/Notes

• Sketch (if applicable)

  Drawing

• Photos & Documents (if applicable)

  Media

• List additional staff/workers that the hazard & controls have been communicated to (if applicable).

Employee

• Employee Sign Off

  Sign

• Department of Transport