Information

  • SR Number

  • Conducted on

  • Prepared by

  • Location
  • Additional Personnel present or additional Auditor

  • Select date

  • Crew being audited.

  • Task being undertaken

  • Enter the names of the crew being audited.

OHS Considerations

  • Has the JSA been completed correctly with all risks identified?

  • Has the JSA been signed by all personnel at the site?

  • Are all personnel on site wearing or carrying their Identification Cards?

  • Is the proper PPE being worn?

  • Is the PPE in good condition and being worn correctly?

  • Is there a First Aid Kit available and is it stocked appropriately for the activity being undertaken?

  • Are proper Health & Hygiene safeguards in place and being practiced?

  • Are all hazardous substances correctly labelled?

  • Is the AVDD unit being used for this task? If so, is it being used correctly and is it within the required calibration period-date? Record the calibration/service date and unit number.

  • Have all other services in the vicinity of the Site been identified and located?

  • Are all activities being conducted within written procedures?

  • Are correct manual handling techniques being used by all personnel?

Traffic & Pedestrian Management

  • Has the Traffic Management Assessment been completed? If so, has the appropriate Traffic Management Plan been implemented?

  • If Traffic Management is being provided by a third party, are their JSA's and Plans completed and appropriate for the task/s being undertaken?

  • Is there appropriate Pedestrian / Traffic protection?

  • Has the worksite been tapped off to prevent unauthorized entry?

  • Are all signs and equipment being used in required condition?

Confined Space Entry

  • Is this activity involving Confined Space Entry?

  • Do all personnel performing the Confined Space Entry have the appropriate training and licenses?

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

  • Is the Confined Space Entry being conducted to the Confined Space Entry Plan?

  • Has the OCC been notified of the Confined Space Entry?

  • Is all PPE being used for the Confined Space Entry in service and in proper condition for it's use?

Vehicles Plant and equipment

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

  • Carry out a vehicle, Plant and Equipment inspection and report any deficiencies.

  • Is there a Fire Extinguisher available, is it secured correctly and is it in service, I.e. been checked and in date with the regular service checks?

  • Is there a refueling container available, is it fitted with a fuel transfer nozzle?

  • Are vehicle and plant log books correctly filled out with any faults listed?

Asbestos Tasks

  • Is there Asbestos removal or repairs involved in this task?

  • Are all personnel involved in the task appropriately trained and certified to carry out asbestos tasks?

  • Is the Asbestos Plan completed and the Supervisor nominated? Note: take specific notice of names and signatures.

  • If so is the appropriate PPE being worn

  • Is the appropriate signage displayed correctly?

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

Environmental Aspects

  • Has the worksite been reinstated as per requirements and standards? (eg. The cleanup of driveways, gutters nature strip etc.)

  • Are silt traps in place to prevent excessive entry into storm water drains? How many are in place?

Customer

  • Have customers been notified of the activity if required?

  • Prior to commencing the activity, have all considerations for customers been taken, I.e. blocked driveways, water off to their property whilst the repairs are being carried out?

  • Has the water been shutdown? Have the "water off" times been minimized?

  • Does the worksite require a specific clean up/ disenfection due to a sewer spill etc.

  • Has there been any damage caused to other assets or customers property?

  • If there are damages, have all of the relevant details been recorded and reported?

Excavation

  • Is the excavation for the activity appropriate in size?

  • Is the excavation over 1.5 mt deep? Are proper shoring devices being used?

  • Does the operator of the excavator have the appropriate license? Who is the appointed operator? Are they licensed? Name the spotter.

  • Was the correct equipment used for the excavation, I.e. shovel digging first and then a mud bucket?

  • Is the available back fill material appropriate, and is there sufficient quantity available to complete the task?

  • Has the excavation been back filled correctly and compacted?

Road opening

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

  • Has the road opening been measured and correctly marked for completion?

M&E / Sewer

  • Is the wet well clean to procedures?

  • Are all alarm inhibit override/s reset?

  • Are all covers correctly refitted and in proper condition?

  • Are log book details entered and station locked up?

Safety Conversations

  • We're any safety conversations conducted during this audit? If so please record the conversation.

Opportunity for Improvement

  • Were there any opportunities for improvement identified during this audit? If so please record the details and ensure that the OFI is reported, registered and followed up.

Sign off

  • Auditor signature

  • Crew signature

  • Crew signature

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.