Field Audit Report & Checklist (Version 7) Issued 25/11/2015

• Audit Title SR Number

• Location
  Address

• Inspection Date:

  Date

• Inspected By:

Crew/Contractor Information

• Select the crew/s from the drop down box. Multiple selections can be made.

  Select A1 Groundforce Allabout Excavations ATMS Citywide Donnaz Evolution Traffic Global Traffic Gramac IV Plumbing Jetstream JMH Excavations L&K Earthworks LMF Maintech McLean Civil Meiss Plumbing Metro Utilities Traffic MRB Excavations Other P&B Plumbing PFM M&E PFM SEWER PFM TRAFFIC PFM WATER Rangedale Rangedale Traffic Management (RTM) RBM Sewer Sunny Excavations Taylord Plumbing Toxfree The Blockage Bloke Underground Logistics 30XY

  • A1 Groundforce
  • Allabout Excavations
  • ATMS
  • Citywide
  • Donnaz
  • Evolution Traffic
  • Global Traffic
  • Gramac
  • IV Plumbing
  • Jetstream
  • JMH Excavations
  • L&K Earthworks
  • LMF
  • Maintech
  • McLean Civil
  • Meiss Plumbing
  • Metro Utilities Traffic
  • MRB Excavations
  • Other
  • P&B Plumbing
  • PFM M&E
  • PFM SEWER
  • PFM TRAFFIC
  • PFM WATER
  • Rangedale
  • Rangedale Traffic Management (RTM)
  • RBM Sewer
  • Sunny Excavations
  • Taylord Plumbing
  • Toxfree
  • The Blockage Bloke
  • Underground Logistics
  • 30XY

• List the names of the crew/s

  Yes

  No

  N/A

• Enter the task being carried out.

  Yes

  No

  N/A

• Are all personnel on site carrying their current CWW ID cards?

  Yes

  No

  N/A
Tap to enter information

Section 1.0 HSEQ Considerations

• 1.1 Has the pre start JSEA been completed correctly with all risks identified? Has the JSEA been signed by all personnel on site? Please take a photo.

  Yes

  No

  N/A
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• 1.2 Have all controls identified on the JSEA been implemented appropriately?

  Yes

  No

  N/A
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• 1.3 Is the proper PPE being worn and in good condition? i.e. long long uniform, hard hats, safety glasses, vests, gloves, etc.

  Yes

  No

  N/A
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• 1.4 Is the AVDD unit being used for this task? If so, is the AVDD unit within calibration date?

  Yes

  No

  N/A
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• 1.5 Are the AVDD cables, earth leads and gloves in good condition? i.e. gloves not torn or have holes, cables do not have bare wires exposed or damaged insulation, earth leads dated and tagged.

  Yes

  No

  N/A
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• 1.6 Are the Main to Meter tickets current? Please take a photo.

  Yes

  No

  N/A

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• 1.7 Is there a first aid kit available and is it appropriately stocked for the activity being carried out?

  Yes

  No

  N/A
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• 1.8 Are all hazardous substances correctly labeled and stored correctly in spill trays?

  Yes

  No

  N/A
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• 1.9 is there a refuelling container available, is it fitted with a transfer nozzle and if a plastic fuel container, is it less than 5 years old? (date of manufacture is stamped on the bottom of plastic fuel containers)

  Yes

  No

  N/A
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• 1.10 Are gas offsets available? If planned or scheduled works, are DBYD plans available, including permits (if required by the DBYD plans)?

  Yes

  No

  N/A
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• 1.11 Is there a pipe locator available and was it used to locate services? Have all other services in the vicinity been located and marked to alleviate accidental strikes?

  Yes

  No

  N/A
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Section 2.0: Traffic and Pedestrian Management

• 2.1 Has the Traffic Management Risk Assessment been completed? Please take a photo.

  Yes

  No

  N/A
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• 2.2 Have all the listed controls that were identified in the risk assessment been appropriately implemented?

  Yes

  No

  N/A
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• 2.3 If the traffic management being provided by a third party, are their JSA'/SWMS and Plans completed and appropriate for the tasks being undertaken? Please take a photo.

  Yes

  No

  N/A
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• 2.4 Are the Traffic Qualifications held by the crew/s appropriate to the task and current, i.e. current and within the three year period? Take a photo of the ticket/s.

  Yes

  No

  N/A
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• 2.5 Is there appropriate Pedestrian/Traffic protection? Provide a photo of the set up.

  Yes

  No

  N/A
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• 2.6 Has the worksite been taped off to prevent unauthorised entry? Double taping is the minimum requirement.

  Yes

  No

  N/A
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• 2.7 Is there 'para webbing' available for use, if required, to prevent entry into the area?

  Yes

  No

  N/A
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• 2.8 Is the site housekeeping orderly with no tools, equipment or slip/trip hazards left on footpaths or public access areas?

  Yes

  No

  N/A
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Section 3.0: Environmental Aspects

• 3.1 Has the worksite been reinstated as per requirements and standards? i.e. clean up of driveways, gutters, nature strip, etc. Please take a photo.

  Yes

  No

  N/A
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• 3.2 Are a minimum of three silt traps correctly placed out to prevent excessive entry of contaminents into storm water drains? List the number of silt traps placed out.

  Yes

  No

  N/A
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• 3.3 Are all silt traps in good condition and able to be used? i.e not split.

  Yes

  No

  N/A
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Section 4.0: Customer

• 4.1 Prior to commencing the activity, have all considerations for customers been taken? i.e. blocked driveways, water off, customers notified (if required) while repairs are being taken.

  Yes

  No

  N/A
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• 4.2 During the task has the water main/service been kept free of contamination?

  Yes

  No

  N/A
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• 4.3 On completion of the task was the main, service, or hydrant flushed and or disinfected to ensure a clean supply?

  Yes

  No

  N/A
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• 4.4 Does the worksite require a specific clean up/disinfection due to a sewer spill etc.?

  Yes

  No
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• 4.5 Has there been any damage caused to other assets or customers property?

  Yes

  No
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• 4.6 If there are damages, have all the relevant details been recorded and reported? Please provide a photo of the damage and complete "Insurance report " and/or "Damage to other services report".

  Yes

  No

  N/A
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• 4.7 Have flanges/fittings etc. where required, e.g. planned or scheduled works, been checked for correct torque on bolts etc. with a tension wrench?

  Yes

  No

  N/A
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• 4.8 Has the task completion or progress been reported back to CWW? Ie. water off reported, job completed (Focus), damage, etc

  Yes

  No

  N/A
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Section 5.0: Vehicles Plant and Equipment

• 5.1 Are all vehicles and equipment in good working order, clean and presentable?

  Yes

  No

  N/A
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• 5.2 Are the correct tools/truck/crew being used for the task, i.e. no cross contamination due to a sewer spill carrying out a water task or vice versa?

  Yes

  No

  N/A
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• 5.3 Are vehicle and plant log books correctly filled out with any faults listed? Provide a photo of the log book/s.

  Yes

  No

  N/A
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• 5.4 Is there a fire extinguisher available, is it secured correctly and is it in service, i.e. been checked and tagged within the last 6 months, if the extinguisher was purchased within the last 6 months, sight the receipt of purchase.

  Yes

  No

  N/A
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• 5.5 Are the probes for locating services in good condition with insulated handles?

  Yes

  No

  N/A
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• 5.6 Is there a "sharps container and sharps grab tool" available?

  Yes

  No

  N/A
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Section 6.0: Confined Space Entry

• 6.1 Does this activity involve "Confined Space" entry?

  Yes

  No

  N/A
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• 6.2 Has the OCC been notified of the Confined Space Entry?

  Yes

  No

  N/A
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• 6.3 Does all of the personnel involved in the Confined Space entry have the appropriate training, qualifications and tickets? Confined Space ticket valid for 12 months only. Please take a photo.

  Yes

  No

  N/A
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• 6.4 Have the correct Confined Space permit/s been obtained and filled out correctly? Take specific notice of the rescue plan and make comments.

  Yes

  No

  N/A
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• 6.5 Is the Confined Space entry being conducted to the Confined Space Entry Plan?

  Yes

  No

  N/A
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• 6.6 Is all PPE used for the Confined Space entry in service and in proper condition for it's use?

  Yes

  No

  N/A
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Section 7.0: Asbestos tasks

• 7.1 Is there Asbestos Removals or Repairs involved in the task?

  Yes

  No

  N/A
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• 7.2 If Asbestos removal is required, is a copy of the contractors Asbestos Removal Licence onsite? Note: PFM Asbestos Removal licence cannot be used by a contractor or vice versa.

  Yes

  No

  N/A

• 7.3 Are all personnel involved in the task appropriately trained and ticketed to carry out asbestos tasks? Asbestos removal ticket must be renewed every 24 months. Provide photo of tickets.

  Yes

  No

  N/A
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• 7.4 Has the Asbestos Control Plan been completed, company name specified and the supervisor nominated? Note: take specific notice of names and signatures, the nominated supervisor must be from the list of supervisors detailed on the licence. Provide photo of the Asbestos Control Plan.

  Yes

  No

  N/A
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• 7.5 Is the correct PPE available for use/being worn? at least P2 dust mask, coveralls, gloves, safety glasses, safety gumboots, etc.

  Yes

  No

  N/A

• 7.6 Has all waste been removed as per the requirements, i.e. double bagged, SR number written on the outer bag.

  Yes

  No

  N/A
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Section 8.0: Excavation

• 8.1 Is the excavation over 1.5 mt. deep? If so, are the correct shoring devices being used or is the excavation "battered back", are appropriate barricades in place, is an access/egress ladders in place, has the excavation been reported to WorkSafe? NB: Notification to WorkSafe not required for emergency works.

  Yes

  No

  N/A
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• 8.2 Does the operator of the excavator have the appropriate licence? Who is the appointed operator? Who is acting as the Spotter and do they hold a current ESV spotter ticket?

  Yes

  No

  N/A
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• 8.3 Has the excavation been backfilled correctly and compacted?

  Yes

  No

  N/A
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Section 9.0: Road Opening

• 9.1 Have the correct materials been used, compacted, all drill holes and cuts been filled?

  Yes

  No

  N/A
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• 9.2 Has the Road Opening been measured and correctly marked for completion?

  Yes

  No

  N/A
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• 9.3 Provide a photo of the road opening.

  Yes

  No

  N/A
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Section 10.0: M&E / Sewer

• 10.1 Is the Wet Well clean and tidy as per procedures and requirements?

  Yes

  No

  N/A
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• 10.2 Are fall from heights barriers available and are they being used?

  Yes

  No

  N/A
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• 10.3 Is the area around the Well/Manhole clear of obstructions that would cause slips, trips or falls?

  Yes

  No

  N/A
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• 10.4 Are all Alarm Inhibit overrides been reset?

  Yes

  No

  N/A
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• 10.5 Are all covers correctly refitted and in proper condition?

  Yes

  No

  N/A
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• 10.6 Are log book details entered and station locked up?

  Yes

  No

  N/A
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• 10.7 Have all materials and rubbish been bagged and removed from the site, i.e. rags, old parts etc.?

  Yes

  No

  N/A
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Section 11.0: Safety Conversations

• 11.1 Were any Safety Conversations conducted during the audit? If so record the conversation.

  Yes

  No
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• 11.2 Has the crew been practicing their stretching and warm up exercises before commencing the task? Crew to demonstrate exercises.

  Yes

  No

  N/A
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• 11.3 Has the crew been conducting "Reset" exercises? Crew to demonstrate reset exercise.

  Yes

  No

  N/A
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• 11.4 Are the correct Manual Handling Techniques being used by all personnel.

  Yes

  No

  N/A

Section 12.0: Opportunities for Improvement

• Are there any Opportunities for Improvement identified in the audit?

  Yes

  No
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• Enter the details of the identified opportunities.

Section 13.0: Signatures and sign off.

• Signature of Auditor/Supervisor/Manager

  Sign

• Signature of Additional Auditor/Supervisor/Manager

  Sign

• Signature of Crew Member 1

  Sign

• Signature of Crew Member 2

  Sign

• Signature of Crew Member 3

  Sign