Downer UFB Site Supervisors Site Inspection

• Document No.

• Work Site Inspection Form CT H M001

• Chorus UFB Operations.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Contractor

Hazard ID

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Service plans and permits?

• Close access permits handed to contractor?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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?

  Media

• Telco marked out in purple?

  Yes

  No

  N/A

• Correct coding in place?

• Gas is marked out in yellow?

  Yes

  No

  N/A

• There is a close access consent in place? Record the number

  Yes

  No

  N/A

• Power marked in orange

  Yes

  No

  N/A

• There is a close consent in place? Record the number.

  Yes

  No

  N/A

• Water potable marked out in blue?

  Yes

  No

  N/A

• Sewer and storm water marked out in correct colours?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Civil excavations

• Excavation material is removed and clear of the trenching?

• Excavations are stable, battered or shored?

• Excavations unattended are made safe I.e. back filled, or closed off with barriers?

• Hazardous work notification in place for excavations over 1.5 metres? (copy must be physically held on site)

Environmental protection

• Record image of sediment control in place.

  Media

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

  Yes

  No

  N/A

• There is spill response equipment on site?

  Yes

  No

  N/A

Personal protective equipment

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Traffic management

• Image of the TMP Signage and setup on site.

  Media

• The CAR NOTICE is on site.

  Yes

  No

  N/A

• CAR IS VALID FOR THE SITE

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• STMS CONTACT details recorded on site.

  Yes

  No

  N/A

• Equipment and plant setup inside the TMP zones?

  Yes

  No

  N/A

• Safe pedestrian access maintained?

• Barriers in good condition and safe?

• Cones in good condition?

• General comments and actions required?

Sign off of prestart inspection

• Contractor/Team Leaders signature

  Sign

• Site Supervisors signature.

  Sign