Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Hazard ID

  • Hazard ID is on site and completed by team before commencing work.

  • Hazards and controls are relevant to the work being undertaken.

Service plans and permits?

  • Close access permits handed to contractor?

  • Service plans on site, current, and complete minimum A3 in size?

MARKOUTS completed for gas, power, telco and water services. (Include other if rel. such as fuel lines?

  • Record image of each of these services marked out on site?

  • Gas is marked out in yellow?

  • Water potable marked out in blue?

  • Power marked in orange

  • Sewer water marked out in red?

  • Storm water marked out in pink?

  • Telco marked out in purple?

  • Critical services marked out I.e. mains, high voltage power, hi cap telco etc.

Environmental protection

  • Record image of sediment control in place.

  • Sediment cloth in place minimum of 50 metres down flow of all excavations including: drilling, trenching, hydro vac, pot holing, etc....

Personal protective equipment

  • Excavation work personnel wearing FR overalls, safety glasses, safety footwear.

  • All traffic management PPE in good condition and worn properly?

Traffic management

  • Image of the TMP Signage and setup on site.

  • The CAR NOTICE is on site.

  • CAR IS VALID FOR THE SITE

  • TMP. Is set up according to those TMP approved in the CAR.

  • STMS CONTACT details recorded on site.

  • Equipment and plant setup inside the TMP zones?

Hydro Excavation Activities

  • Work activity is isolated from general operations

  • Operator is wearing correct PPE

  • Safety glasses

  • Hearing protection

  • Hard hat

  • Splatter guard in place

  • Full body FR overalls

  • Safety footwear

  • Face shield

  • Splatter prevention in use

  • Operational pressure is below 2000 psi

Sign off of prestart inspection

  • Contractor/Team Leaders signature

  • Site Supervisors 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.