DRAFT Daily Site Specific Risk Assessment and Checklist - Community Planning & Projects - V1.0

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

  Select
• Location
  Address

• Yes

  No

  N/A

• Project Title:

• Date:

  Date

• Job No.:

• Site Supervisor:

• Location:
  Address

• Description of Work:

RISK ASSESSMENT

Work Activity

• Reference

Documents

• (e.g. SWMS, SWI, TCP No., Procedure No.)

• Hazards with potential to cause serious injury or fatality

  Yes

  No

  N/A

• (Description of Hazard or Risk)

• Risk

  Yes

  No

  N/A

• Rating

Control Measures

Elimination / Substitution / Isolation / Engineering / Administration PPE

New Risk

• Rating

• Tool Box Talk – Items Discussed

• Name & Signature

  Sign

• Name & Signature

  Sign

• Name & Signature

  Sign

• Name & Signature

  Sign

• PERSONS PRESENT

  Yes

  No

  N/A

• Unique Document Number: SM005

• Document Name: Site Specific Risk Assessment & Checklist

Responsible Group: Assets & Works

• TRIM Reference: 3714E D17/166421

  Yes

  No

  N/A

• Adopted: 14/07/2009

  Yes

  No

  N/A

• Last Amended:

• Review Date:

  Date

• Version:

Page

• 1 of 2

  Yes

  No

  N/A

Daily Site Specific Risk Assessment and Checklist

• Start-up – Checks before the planned activities commence

  Yes

  No

  N/A

• If YES, please complete Risk

  Yes

  No

  N/A

• Cones on both sides of roadway,

  Yes

  No

  N/A

• 3.0m either side of cables

  Yes

  No

  N/A

• TCP No

• Time:

  Date

• Time: am / pm

  Date

Risk Assessment

Site Workers

• Site Specific Risk Assessment completed

  Yes

  No

  N/A

• Have individuals had the opportunity to “warm up”

  Yes

  No

  N/A

• Do any individuals have physical constraints or restrictions

  Yes

  No

  N/A

• Have all workers been inducted

  Yes

  No

  N/A

Traffic Management

• Are weather conditions suitable for work

  Yes

  No

  N/A

• TCP utilised

  Yes

  No

  N/A

• Any modifications to TCP required

  Yes

  No

  N/A

• TCP implemented (last sign erected)

  Yes

  No

  N/A

Inspection drive

• Traffic Controllers Name/s

Personal Protective Equipment

• Is appropriate PPE available

  Yes

  No

  N/A

Plant & Equipment

• Are all Plant checklists completed

  Yes

  No

  N/A

Work Practices

• Are Plant capable of doing the days activities safely

  Yes

  No

  N/A

• Are planned manual handling tasks appropriate

  Yes

  No

  N/A

Environmental Measures

Commence Work

• The site and workers are ready for the days activities

  Yes

  No

  N/A

•  Work commenced at –

  Date

• Time: am / pm

  Date

• Shut Down – Checks after the planned activities are completed

  Yes

  No

  N/A

• First sign covered / removed

  Yes

  No

  N/A

• Time: am / pm

  Date

Site Workers

Site Conditions

• Have all incidents been treated and reported

  Yes

  No

  N/A

• Are signs suitable for after hours warnings

  Yes

  No

  N/A

• Are barricades appropriate and properly erected

  Yes

  No

  N/A

• Have all trip hazards been removed or isolated

  Yes

  No

  N/A

• Have security arrangements been organised

  Yes

  No

  N/A

Close Site

• Are Plant securely locked down / parked up

  Yes

  No

  N/A

•  Site closed at –

  Yes

  No

  N/A

• Time: am / pm

  Date

• Unique Document Number:

• SM005

  Yes

  No

  N/A

• Document Name:

Site Specific Risk Assessment & Checklist

• Responsible Group:

Assets & Works

• TRIM Reference:

• Adopted: 14/07/2009

  Yes

  No

  N/A

• Last Amended:

• Review Date:

  Date

• Version:

Page

• 2 of 2

  Yes

  No

  N/A