Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Installation Quality
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Duct at correct depths at
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Photo evidence of ducts
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Action to be taken?
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Is the job being built according to the plans?
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Has the duct been rolled off using the correct proceedure?
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Add media
Working at heights
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Fall risks of 2m or more (including voids, pits and trenches)
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Add media
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Lack of edge protection?
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Add media
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Unsafe of incomplete edge protection?
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Add media
Emergency Response
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Lack of or no emergency plans for site?
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Add media
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Emergency procedures not displayed on site?
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Add media
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Lack of or inadequate first aid kits and equipment on site
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Add media
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Trained first aider on site?
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Unsuitable or inadequate communication equipment?
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Add media
Traffic Management
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Lack of or inadequate traffic management plan on site?
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Add media
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Inadequate controls for TMP? i.e incorrect signage, barriers, speed limits
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Add media
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Are there signs 50m from work site?
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Add media
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Is there room for pedestrians to safely walk down the road?
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Photos of incorrect pedestrian access
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Action taken?
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Add media
Personal Protective Equipment (PPE)
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Lack of, incorrect user or inadequate PPE?
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Action taken?
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Lack of system to issue, inspect, replace and monitor PPE?
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Work Environment
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Insufficient lighting?
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Add media
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Lack of or inadequate noise/vibration control?
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Add media
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Site Cleanliness?
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Add media
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Have all trip hazards been eliminated?
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Add media
Environmental Hazards
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Lack of or inadequate environmental management plan?
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Add media
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Lack of or inadequate dust suppression system?
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Add media
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Lack of or inadequate systems to prevent contamination entering stormwater drains?
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Add media
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Cess pit covers in place?
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Add media
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Socks around drill?
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Add media
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Dirt piles are all 600mm from gutter or covered?
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Add media
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Is there any over run of dirty water near gutters?
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Administration Procedures?
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Are all service plans on site?
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Council permits on site
Follow Up Actions
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Enter any follow up actions that will be undertaken?
Sign off
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