Title Page

  • Document No.

  • Field Asset type

  • Network Region

  • Specify

  • FSP

  • Specify

  • Are any Job permits in use?

  • Specify

  • Type of Work

  • Old Field Asset #

  • Type of Project

  • Field Asset # (or WBS if no Field Asset #)

  • Vector Workpack # and Name

  • FSP Job #

  • On-site supervisor

  • Conducted on

  • Location
  • Weather Conditions

  • Name & Signature

Audit Section

PLANNING & COMMUNICATION

  • Site safety management plan in place, current and adhered to (Eg. hazard Id, JRA, JSA)

  • Daily tailgate/toolbox briefings occurring

  • Employees signed-on to ensure they understand the work methods

  • Visitors signing on/off tailgate or visitors register

  • Permits to Work being issued, managed & terminated correctly

  • Staff training(including contractors) & competency records/certificates available on site and current eg. WTC/COC, work site safe, Drivers License (sample check and list names)

Permits

  • Are any permits in use?

  • What type of permit?

  • Permits to Work being issued, managed & terminated correctly

  • Have all workers in permit area signed onto permit?

PUBLIC PROTECTION

  • Adequate signage around the perimeter (if required)

  • Safe access/egress from site

  • Site parking controlled (as required)

  • Temporary barriers are in place

PERSONAL PROTECTIVE EQUIPMENT & CLOTHING (PPE/PPC)

  • Hard Hats worn (where required)

  • High visibility clothing worn

  • Safety footwear worn that complies with site requirements

  • Eye protection worn (where required)

  • Face Shields in use (where required)

  • Hearing Protection worn

  • Respirators or masks worn (where required)

  • Appropriate PPE and PPC worn ie. switching jackets & insulating gloves, chemical handling

  • PPE & PPC is in good condition

SUBCONTRACTORS

  • Are any subcontractors onsite?

  • Subcontractors Site Specific Safety Plans in place, agreed & implemented

  • Subcontractors have identified significant hazards they are introducing to site and entered on site hazard register

  • Subcontractors controlling hazards identified onsite

  • Subcontractors informed of our site hazards likely to affect them (inductions, briefings)

  • Subcontractors have provided MSDS sheets for all hazardous substances on site (where applicable)

  • Subcontractors have provided Equipment Certificates where required

LADDERS

  • Are ladders in use?

  • Ladder is the most appropriate access solution for the task

  • Suitable for the job i.e. commercial/industrial grade not domestic.

  • Ladders are in good condition

  • Ladders set up on firm level ground

  • Ladders secured (base and/or top)

  • Ladders at correct angle - 4 up to 1 out

  • Ladders project 1m above step off point

  • Step ladder lock bars in place

  • Operator not working on top two steps of ladder

WORK AT HEIGHT

SAFETY HARNESS & STATIC LINES (this may not be relevant)

  • Is height work involving safety harness being carried out? (not including pole work)

  • Plan developed for harness use and workers signed onto plan

  • Workers briefed and signed onto rescue plan

  • Harness uses supervised by worker holding US15757

  • Harnesses used and fitted correctly

  • Harnesses, anchors, static lines and rescue equipment in good condition

SCAFFOLD

  • Is any scaffold in use?

  • Wheel brakes fitted and locked when scaffold in use (mobile only)

  • Scaf-tag / acu-log tag fitted to scaffold (not req for mobile)

  • Harnesses, anchors, and rescue equipment in good condition and controls in place (not req for mobile)

  • Harnesses used and fitted correctly

ELEVATED WORK PLATFORMS (Cherry Pickers/Scissor Lifts/Knuckle boom)

  • Are any EWPs in use?

  • Current certificate of fitness and mechanical test attached to unit (6 monthly)

  • Set up on level ground and bonded to earth as required

  • Outriggers properly extended before use (where fitted)

  • Fall arrest harnesses being worn

-----****BREAK LINE BREAK***----

  • Is it a multi-day project site? --(BREAK)--

  • Site specific PPE requirements are sign posted and adhered to (where applicable)

  • Crossings clear with no obstructions

  • Visitor control operating correctly

  • Are substations secured against access by unauthorised persons?

SYSTEMS & FACILITIES

PLANNING & COMMUNICATION

  • Daily tailgate briefings occurring

  • Employees signed-on to ensure they understand the work methods

  • Assembly areas established & displayed on site

  • Visitors signing on/off tailgate or visitors register

  • Site-specific inductions being carried out for all site staff

  • Permits to Work being issued, managed & terminated correctly

  • Staff training(including contractors) & competency records/certificates available on site and current eg. WTC/COC, work site safe, Drivers License (sample check and list names)

  • Copy of CAR on site?

  • Copy of relevant consents on site?

PROJECT HAZARD MANAGEMENT

  • Site Hazard Board in place

  • Hazard register current and reflect site hazards

  • Worksite being reviewed daily for new/changed/removed conditions

  • Regular site safety meetings held and minuted

  • Significant or specialised (non-routine) tasks been identified and SWMS (Safe Work Method Statement) or JSA(Job Safety Analysis) documented

  • Safety inspection roster used and implemented

HEALTH & ENVIRONMENT

  • Hazardous substances have been identified (toxins, biological, lead, asbestos) and controlled

  • There materials on site to deal with spillages (oil dry etc)

  • Noise levels controlled and monitored

  • Dust controlled and monitored

  • Workers provided with the appropriate environmental protection ie. hydration, cover, sunblock

EMERGENCY PROCEDURES

  • There is an emergency response plan

  • Emergency procedures established & available on site

SITE ACCOMMODATION

  • Site Sheds installed correctly (Level/Stable/Height)

  • Site sheds display current electrical certificates (6 monthly)

  • Site sheds appliances display current electrical certification (3 monthly)

  • Waste and drainage conforms to requirements (safe & Sanitary)

  • Site offices clean & tidy

  • Toilet areas clean & tidy

  • Lunch room & food prep area clean - hand washing facilities been provided

  • Adequate lighting

  • Safe Access/egress provided to site accommodation and evacuation point identified

  • First aid kits in place & well stocked

  • Fire extinguishers available, charged & current (Serviced 12 monthly)

GENERAL SAFETY

SITE ACCESS/EGRESS

  • Access routes adequately sign posted where required

  • Access routes kept clear and free of obstructions

  • Access routes have fall protection where required

  • Ramps and stairs conform (grade, handrails etc)

  • Good access provided to the workface

  • Unloading/storage/material handling being controlled

  • Wheel wash facilities operating where required

HOUSEKEEPING & ENVIRONMENT

  • Work areas clean & tidy

  • Materials stacked safely

  • Rubbish bins provided (where required)

  • Combustible materials stowed

  • Hazardous materials controlled

  • Slips & trips controlled

  • All electronic devices used on site are work related and not taken into exclusion zones

GENERAL HAZARDS

  • Loads being manually handled/moved correctly (Mechanical devices used where possible)

  • Machinery moving parts properly guarded

VEHICLES & MECHANICAL PLANT

SITE VEHICLES/MACHINES (Quarry Trucks, Hiabs, Dozers etc)

  • Competent operators/drivers

  • Vehicle loads are secure when travelling

  • Outriggers extended where required

  • Feet on stable ground

CRANES

  • Current certificate of fitness

  • There ia a radius chart in the cab

  • Safe load indicator fitted/operational

  • There is enough clear room for operation

  • Slings, chains, lifting beams regularly checked/tested

LIFTING EQUIPMENT

  • Slings and shackles load rated and 'In test' tag attached

  • Soft Slings in good condition: no fraying

  • Wire/Chain Slings in good condition: no kinks

  • Slings in good condition: Eyes not stretched, bent or fraying

  • Shackles in good condition: shackle pins aligned, threads ok

  • Adequate storage of lifting equipment

  • Hooks in good condition. Not distorted or damaged

  • Hook safety catches in good condition/operational

HELICOPTER

  • All workers are signed on to the Pilot Safety briefing

  • All workers are in the Pilot's line of sight

  • All loose objects have been secured including hard hats

MACHINERY & TOOLS

ELECTRICAL

  • Lockout procedure developed for permanent supply

  • Lockout procedure in use where appropriate

  • No work on “Live” electrical equipment

  • Main switchboard door locked

  • ELCB’s/RCD’s/Transformers used where required.

  • Commercial splitter boxes & double adaptors only in use with RCD.

HAZARDOUS ACTIVITIES

EXCAVATIONS & TRENCHES

  • Notification sent if deeper than 1.5 metres

  • If greater than 1.5m, there is an entry/exit plan implemented

  • Underground services location drawings on site prior to ground works

  • Underground services located/marked prior to excavating

  • Underground services located by potholing at frequent intervals as required

  • Permit to excavate held at work face (if applicable)

  • Shoring methodology developed. (ensure workers not in danger installing)

  • Sides battered/benched for trench or excavations >1.5m deep or in friable ground

  • Machines working safe distance from edge of excavation.

  • Overburden/machinery well clear of the edge (600mm)

  • Daily inspections for stability – especially during wet weather

CONFINED SPACES

WORKING ON THE ROAD

  • TMP has been approved by Road Controlling Authority (NZTA, local authority

  • There is a copy of the TMP on site

  • The site/project setup conforms to the TMP

  • There a qualified Traffic Controller on site

  • An STMS has been appointed for the work and wearing the correct high visibility vest

  • The supervisors know who the STMS is and how to contact them

  • All workers wearing NZTA approved hi-vis clothing ie. in good condition and worn appropriately

CHEMICAL HANDLING/STORAGE

  • MSDS’s available for all chemicals/solvents/hazardous materials (dated < 5years?)

  • Hazardous material clearly identified

  • Hazardous materials properly stored

  • Hazardous materials properly handled/used

  • Chemicals stored in approved containers

  • Users of hazardous materials properly informed

  • Adequate ventilation provided (where necessary)

  • Chemical container/residue disposal properly controlled

WORK PROGRESS

  • The scope of works is being followed

  • The work is being performed to network standards

  • Issues are being identified and communicated

  • The work is progressing to programme

  • Quality assurance standards are being met

  • If Live Line, is the work in accordance with the Live Line proposal and permit?

  • If isolated, is the isolation in accordance with the Switching Plan?

  • Has the Testing & Commissioning checklist been completed?

  • Are MADs being observed where applicable?

  • Does live line work meet ECP46 / EOS 006?

  • Has existing/new conductors been isolated/earthed during stringing of additional conductors?

  • Are all person clear from the cross-arm of the pole during strining and tensioing?

  • GENERAL COMMENTS

  • ASSESSORS SECTION

SYSTEMS & FACILITIES

PLANNING & COMMUNICATION

  • Site safety management plan and/or tailgate in place, current and adhered to

  • Daily tailgate briefings occurring

  • Employees signed-on to ensure they understand the work methods

  • Assembly areas established & displayed on site

  • Visitors signing on/off tailgate or visitors register

  • Site-specific inductions being carried out for all site staff

  • Permits to Work being issued, managed & terminated correctly

  • Staff training(including contractors) & competency records/certificates available on site and current eg. WTC/COC, work site safe, Drivers License (sample check and list names)

  • Copy of CAR on site?

  • Copy of relevant consents on site?

HEALTH & ENVIRONMENT

  • Hazardous substances have been identified (toxins, biological, lead, asbestos) and controlled

  • There materials on site to deal with spillages (oil dry etc)

  • Noise levels controlled and monitored

  • Dust controlled and monitored

  • Workers provided with the appropriate environmental protection ie. hydration, cover, sunblock

SUBCONTRACTORS

  • Subcontractors Site Specific Safety Plans in place, agreed & implemented

  • Subcontractors have identified significant hazards they are introducing to site and entered on site hazard register

  • Subcontractors controlling hazards identified onsite

  • Subcontractors informed of our site hazards likely to affect them (inductions, briefings)

GENERAL SAFETY

PUBLIC PROTECTION

  • Adequate signage around the perimeter (if required)

  • Safe access/egress from site

  • Site parking controlled (as required)

  • Visitor control operating correctly

  • Temporary barriers are in place

  • Are substations secured against access by unauthorised persons?

LADDERS

  • Ladder is the most appropriate access solution for the task

  • Ladders are in good condition

  • Ladders set up on firm level ground

  • Ladders secured (base and/or top)

  • Ladders at correct angle - 4 up to 1 out

  • Operator not working on top two steps of ladder

HOUSEKEEPING & ENVIRONMENT

  • Work areas clean & tidy

  • Materials stacked safely

  • Rubbish bins provided (where required)

  • Hazardous materials controlled

  • Slips & trips controlled

  • All electronic devices used on site are work related and not taken into exclusion zones

PERSONAL PROTECTIVE EQUIPMENT & CLOTHING (PPE/PPC)

  • Hard Hats worn (where required)

  • High visibility clothing worn

  • Safety footwear worn that complies with site requirements

  • Eye protection worn (where required)

  • Face Shields in use (where required)

  • Hearing Protection worn

  • Respirators or masks worn (where required)

  • Appropriate PPE and PPC worn ie. switching jackets & insulating gloves, chemical handling

  • PPE & PPC is in good condition

GENERAL HAZARDS

  • Loads being manually handled/moved correctly (Mechanical devices used where possible)

VEHICLES & MECHANICAL PLANT

SITE VEHICLES/MACHINES (Quarry Trucks, Hiabs, Dozers, Cranes etc)

  • Competent operators/drivers and operator safety precautions in place

  • Vehicle loads are secure when travelling

  • Outriggers extended where required

  • Feet on stable ground and chasis bonded to earth where required

  • Current certificate of fitness

  • There ia a radius chart in the cab

LIFTING EQUIPMENT

  • Lifting equipment load rated and 'In test' tag attached

  • Wire/Chain/Slings in good condition: no kinks, fraying, streched or bent

  • Shackles in good condition: shackle pins aligned, threads ok

  • Adequate storage of lifting equipment

HELICOPTER

  • All workers are signed on to the Pilot Safety briefing

  • All workers are in the Pilot's line of sight

  • All loose objects have been secured including hard hats

MACHINERY & TOOLS

ELECTRICAL

  • Lockout procedure developed in use, access and test permits and live line permits

  • Lockout procedure in use where appropriate equipment isolated locked and tagged

  • EPZ zone created, portable earths and dielectric bods

  • Live line cover up inspected and in "test" and correct class

  • All second points of contact covered and safety observer identified and in place

  • Insulating component of EWP cleaned and safety marker visible while in contact area

  • Cover up aplied to lower circuit as required

HAZARDOUS ACTIVITIES

EXCAVATIONS & TRENCHES

  • Notification sent if deeper than 1.5 metres. If greater than 1.5m, there is an entry/exit plan implemented

  • Underground services location drawings on site prior to ground works

  • Underground services located/marked prior to excavating

  • Underground services located by potholing at frequent intervals as required

  • Permit to excavate held at work face (if applicable)

  • Shoring methodology developed. (ensure workers not in danger installing)

  • Sides battered/benched for trench or excavations >1.5m deep or in friable ground

  • Machines working safe distance from edge of excavation.

  • Overburden/machinery well clear of the edge (600mm)

  • Daily inspections for stability – especially during wet weather

WORKING ON THE ROAD

  • TMP has been approved by Road Controlling Authority (NZTA, local authority

  • There is a copy of the TMP on site

  • The site/project setup conforms to the TMP

  • There a qualified Traffic Controller on site

  • An STMS has been appointed for the work and wearing the correct high visibility vest

  • The supervisors know who the STMS is and how to contact them

  • All workers wearing NZTA approved hi-vis clothing ie. in good condition and worn appropriately

CHEMICAL HANDLING/STORAGE

  • MSDS’s available for all chemicals/solvents/hazardous materials (dated < 5years?)

  • Hazardous material clearly identified

  • Hazardous materials properly stored

  • Hazardous materials properly handled/used

  • Users of hazardous materials properly informed

  • Adequate ventilation provided (where necessary)

  • Emergency proceedures identified and documented

WORK PROGRESS

  • The scope of works is being followed

  • The work is being performed to network standards

  • Issues are being identified and communicated

  • The work is progressing to programme

  • Quality assurance standards are being met

  • If Live Line, is the work in accordance with the Live Line proposal and permit?

  • If isolated, is the isolation in accordance with the Switching Plan?

  • Has the Testing & Commissioning checklist been completed?

  • Are MADs being observed where applicable?

  • Does live line work meet ECP46 / EOS 006?

  • Has existing/new conductors been isolated/earthed during stringing of additional conductors?

  • Are all person clear from the cross-arm of the pole during strining and tensioing?

  • GENERAL COMMENTS

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.