Field Inspection

• Worker Name (first & last)

• Designation

• Date of assessment

  Date

• Tools/Equipments/Vehicles Used

  Select Forklift Gas cylinders UTE Prime mover Dolly Truck Compressor OET Crane

  • Forklift
  • Gas cylinders
  • UTE
  • Prime mover
  • Dolly
  • Truck
  • Compressor
  • OET Crane

• Worker Observation

• Worker assessment to be completed once per worker per month. This checklist should also be used to assess a new hire or a returning worker that has been away from the job for more than 6 weeks. Check appropriate boxes if "unsafe" or mark N/A. If "unsafe", provide corrective action comments for worker.

• Location

  Finishing

  Repairs

  Prep

  Sub 3

  Western Wing Aluminium Section

• Started working from

  Date

Company Policies & Procedures

Emergency Response Plan (ERP)

• Can locate Muster Point

  Yes

  No

  N/A

• Knows personal location on a map

  Yes

  No

  N/A

• Can identify FA attendant(s)

  Yes

  No

  N/A

Safe Work Procedures for task

• Can identify workplace hazards

  Yes

  No

  N/A

• Is alert and focused on job

  Yes

  No

  N/A

• Demonstrates safe use of tools & equipment (

  Yes

  No

  N/A

• Uses 3 point mount / dismount

  Yes

  No

  N/A

• Has pre-operational checklist(s)

  Yes

  No

  N/A

• Has required licence / certificates(s)

  Yes

  No

  N/A

• Demonstrates proper use of seat belt

  Yes

  No

  N/A

• Know how to report an incident

  Yes

  No

  N/A

Before "clear to approach" signal given

• Stops work & makes eye contact

  Yes

  No

  N/A

• Stops all moving parts or tools

  Yes

  No

  N/A

• Lowers blade / boom / head / saw

  Yes

  No

  N/A

• Gives "clear to approach" signal

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Is employee's hair secured around moving machinery?

  Yes

  No

  N/A

• Uses appropriate eye / face protection

  Yes

  No

  N/A

• Uses required hearing protection

  Yes

  No

  N/A

• All jewellery is secure and not set loose.

  Yes

  No

  N/A

• Wears appropriate footwear for job

  Yes

  No

  N/A

Potential power sources

• If using Oxy-acetylene cylinders, know what flash back arrestors are?

  Yes

  No

  N/A

• Compressed air used and is controlled ?

  Yes

  No

  N/A

• Plugged in Hoses and cables intact (Cylinders, tanks, hoses etc.)

  Yes

  No

  N/A

• If any lifting equipment used. Know the load limits?

  Yes

  No

  N/A

• Which lifting equipment. What is the load limit?

General

• Area kept tidy and no risk of Slip, trip and falls.

  Yes

  No

  N/A

• Waste pieces, off cuts are disposed in designated containers.

  Yes

  No

  N/A

• Electrical tools and equipments are test and tagged and valid

  Yes

  No

  N/A

• Safety signages adequately provided? (If no, please mention which signage in the comment section )

  Yes

  No

  N/A

• Worker have all adequate tools for the work

  Yes

  No

  N/A

• Does the worker require any training? If yes, please mention it in the comments.

  Yes

  No

  N/A

• Which training?

• An induction was given to the worker when started?

  Yes

  No

  N/A

• All vehicles used by the worker ok with daily checks and serviced?

  Yes

  No

  N/A

• Yes

  No

  N/A

Sign Off

• Signature of Employee / Contractor

  Sign

• Signature of Supervisor / Trainer

  Sign