DSTI - duplicate

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

  Select
• Location
  Address

General Information

• - COMPANY : Skywire

• - AREA :

• - DATE & REF :

  Date

• clean & tidy

  Yes

  No

  N/A

• - Sufficient/correct barricading erected

  Yes

  No

  N/A

• - Electrical equipment in good condition

  Yes

  No

  N/A

• - Machine guarding adequate

  Yes

  No

  N/A

• - All tools/equipment pre-inspected

  Yes

  No

  N/A

• - Safe access & egress available and used

  Yes

  No

  N/A

• - Interfacing with other activities

  Yes

  No

  N/A

• - Gas-cutting equipment & hoses

  Yes

  No

  N/A

• - Correct P.P.E (Utilised & available)

  Yes

  No

  N/A

• - Safe working platforms for elevated work

  Yes

  No

  N/A

• - Safe Lifting & Rigging equipment

  Yes

  No

  N/A

• - LOCK-OUT REQUIRED AND IN PLACE?

  Yes

  No

  N/A

• - HIGH-RISK AREAS RESTRICTED

  Yes

  No

  N/A

• wind/rain / heat/cold

  Good

  Fair

  Poor

  N/A

• - Employees Physical & Mental wellbeing?

  Good

  Fair

  Poor

  N/A

• Was this an injury on duty

  Yes

  No

  N/A

• Do You need medical help

  Yes

  No

  N/A

• Do you need medical help

  Yes

  No

  N/A

• - HIGH-RISK ACTIVITIES / CONDITION

  Yes

  No

  N/A

• LIST POTENTIAL AND EXISTING HAZARDS

• - LIST CONTROLS REQUIRED

Daily Safe Task Instruction

• If tasks change, this list and the Risk Assessment must be revised before proceeding with new/changed task. A signed attendance register must be attached to this list.

• I hereby certify that the above items were checked and all workers under my supervision received a safe task instruction:

  Sign

• Responsible Person Pre-inspection (Construction Supervisor) Print Name Signature:

  Select

DSTI ACKNOLEGEMENT

• I, The undersigned, hereby acknowledge that the relevant hazards as identified on the DSTI, was communicated to me and I understand and acknowledge the safety instructions and control measures relevant to my activities. I furthermore undertake to ensure compliance with the safety regulations and instructions noted. I hereby commit myself to create and maintain a safe work environment.

• Name & Surname ID Number Occupation Company Signature

• 1

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• Add signature

  Sign

• 2

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• Add signature

  Sign

• 3

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• Add signature

  Sign

• 4

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• Add signature

  Sign

• 5

  Select

• Add signature

  Sign

• 6

  Select

• Add signature

  Sign