FCNSW Road Take 2

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

STOP

• Do you understand this task?

  Yes

  No

  N/A

• Are you competent and authorised to do this task?

  Yes

  No

  N/A

• Are your tools in good working order, clean and clear of debris and tagged as needed?

  Yes

  No

  N/A

• Have you got the right PPE for this task eg gloves, eyewear, barricades etc

  Yes

  No

  N/A

• Have you got a site safety plan for this job?

  Yes

  No

  N/A

THINK

• Have you read and understand the safe work procedure for this task?

  Yes

  No

  N/A

• Hazard assessment - can you be caught in, on or between anything?

  Safe

  At Risk

  N/A

• hazard Assessment -Can you struck by moving object or plant

  Safe

  At Risk

  N/A

• Hazard Assessment - are slips, trip or falls likely?

  Safe

  At Risk

  N/A

• Hazard Assessment - Are there dangerous trees that can affect your work?

  Safe

  At Risk

  N/A

• Hazard Assessment - can your work affect someone else's safety?

  Safe

  At Risk

  N/A

PLAN

• Please add in any extra controls you might need that you have not already identified.

• Controls

  Select signs barricades cleared pathways additional PPE communication plan tags, permits etc working alone procedure

  • signs
  • barricades
  • cleared pathways
  • additional PPE
  • communication plan
  • tags, permits etc
  • working alone procedure