Checklist & Discussion Guide

PCBU Representative

PCBU's Representative Name:

Employee Representative Name:

Phone Number:

E-Mail:

Privacy / Consent Statement The personal information provided will be used to assist SafeWork NSW to establish and monitor work health and safety initiatives regarding tree work and to contact industry participants for follow-up survey and/or research. The personal information supplied will be restricted to SafeWork NSW employees, agents and contractors. I voluntarily agree to provide my details and agree to SafeWork NSW contacting me from time to time about tree work, or any other related program and/or services such as safety information, small business rebates and follow-up surveys. I understand I may request to SafeWork NSW to amend any of the details on this form and/or revoke this consent at any time by contacting SafeWork NSW on 131050 or writing to SafeWork NSW at Locked Bag 2906, Lisarow, NSW, 2252.

PCBU - Privacy consent statement:
“I agree to provide the personal information contained in this form. I have been provided with a copy of the Privacy / Consent Statement and I understand the term of the statement which includes my consent for SafeWork NSW to contact me in the future for safety information on tree work, small business rebates and/or follow-up survey as described in the Privacy / Consent Statement”

Name:
Planning work for the identification of hazards and managing risks - WHS Regulation 2011, Section 19, Clauses:32-38, 54 & 78

Do you conduct a visual assessment of the tree prior to starting work to identify hazards/faults?
i.e. bark inclusions, decay, hollows, unstable root plates, hanging branches, deadwood, dead trees, etc.

Do you conduct an assessment of the site to ensure the identification of hazards?
i.e. ground & weather conditions, power lines, underground assets, traffic, insects, slips and trips, etc.

Do you consider the hierarchy of control when selecting control measures to manage the risks that may arise from identified hazards? (This must be done in accordance with part 3.1)
i.e. tree felling, specific plant, rigging systems, climbing, etc.

Consultation, Co-operation & Co-ordination - WHS Regulation 2011, Clauses: 46-49

Do you have a system to consult with workers / others about hazards and risks that can affect their health and safety?
i.e. the system of work being used, traffic control, plant, exclusion zones, etc.

What are the consultative arrangements?

If other please provide comment:

Emergency procedures and worksite communications - WHS Regulation 2011, Section 19, Clauses: 42-43

Do you have emergency procedures in place that allows for an effective response to various emergency situations?
i.e. working at heights (aerial rescue kit), medical (first aid kit), fire (fire extinguisher), etc.

Are appropriate communication methods available and agreed before work commences?
i.e. two way radios, bluetooth helmet headsets, hand signals, whistles and / or mobile telephones.

Is at least one ground worker competent to conduct an aerial rescue either by climbing, using an EWP, or crane access method depending on the equipment available?

Traffic & Pedestrian Management - WHS Regulation 2011, Section 19

Are adequate traffic management measures are in place to protect workers, motorist and pedestrians?
i.e. traffic management may include an appropriate combination of warning signs (specific to falling object risks), witches hats, flashing amber lights, delineation of work site, etc.

Personal Protective Equipment - WHS Regulation 2011, Clause 44

Is PPE provided to and used by workers as required?
i.e. eye protection, hearing protection, safety helmets, safety boots, gloves, hi-vis clothing, cut resistant pants/chaps, etc

Is appropriate sun protection supplied to and used by all workers?
i.e. sunscreen, sunglasses, hats with legionnaires flap, long sleeved shirts where appropriate , etc.

Hazardous Manual Tasks - WHS Regulation 2011, Clauses: 60(part3.1), &34-38

Have manual tasks been identified and are control measures implemented and reviewed to minimise risks?
i.e. excavators, loaders, winches, log trolleys, friction drum, port wrap, 2 person lift, speed line, etc.

Electricity - WHS Regulation 2011, Section 19 & Clause 166

Are safe approach distances for work near overhead power lines identified and observed in accordance with the Work near overhead power lines – Code of Practice 2006?

Hazardous Chemicals - WHS Regulation 2011, Part 7.1

A hazardous chemical register is maintained that includes SDS for all hazardous chemicals (fuel, herbicides, etc) used in the workplace from time to time. SDS are less than 5 yrs old & GHS compliant.

The register of hazardous chemicals is readily available to all workers on site.

Plant & Equipment - WHS Regulation 2011, Section 19 & Clauses 213 & 221
What Plant and Equipment are regularly used by the PCBU?

Please provide comment

Is a pre-start safety check conducted on all plant & equipment?
i.e. emergency stops, bump bars, guards in place and functioning, ropes, harnesses, etc

Is plant & equipment adequately maintained & inspected in accordance with the manufacturer’s instructions or the recommendations of a competent person?

Are safe systems of work in place for the operation and use of plant and equipment?
i.e plant is set up with sufficient clearance to prevent entanglement from ropes or risk of falling objects.

Are systems of work for crane use in place to ensure;
- Loads are lifted within the cranes rated capacities.
- Dogman, climber and crane operator co-ordinate to determine the safest rigging method and attachment point on the load.
- The cutting technique is discussed and the load travel path is determined.
- The climber’s attachment to the crane when being placed into the tree using the crane access method.

Do plant operators hold a current and valid high risk work licence?
i.e. EWP (11m +) & crane.

Information, Training & Instruction - WHS Regulation 2011, Clause 39

Is information, training and instruction provided to workers in relation to plant?
i.e. wood chippers, climbing equipment, lowering equipment, etc.

Is information, training & instruction provided to workers in relation to climbing?
i.e. the setting, selection and suitability of climbing rope anchor points.

Is information training and instruction provided to workers in relation to task specific activities?
i.e. hazardous manual tasks, chipper, lowering, rigging, exclusion zones, site communications, etc.

Have workers who work near overhead power lines have had electrical awareness training?

Incident Notification - WHS Regulation 2011, Clauses 35-39

Are systems are in place to notify SafeWork NSW of serious injuries, illnesses and dangerous incidents as soon as becoming aware of them?

Workers Compensation

Is a current W/C policy in place and does it cover all deemed workers?

Name of Insurer:

Policy Number:

WIC:

Policy Expiry Date:

Number of Employees:

Wages Estimate:

Have all deemed workers been identified for the purpose of W/C?
I.e. in some circumstances, this may include contractors and others.

Is there an injury register which records all injuries and are all injuries reported to the insurer?

Return To Work (RTW)

Category one employer (basic tariff premium exceeding $50,000)
Have you developed a RTW program in accordance with SIRA’s Guidelines for workplace return to work programs?

Category one employer (basic tariff premium exceeding $50,000)
Do you have an appropriately trained and experienced RTW coordinator?

Category two employer (basic tariff premium under $50,000)
Have you adopted the standard RTW program prepared by SIRA or an equivalent?

Is a RTW program on display or do all workers have access to the document?

Can you demonstrate an awareness of your recover at work/ return to work obligations?
i.e. offering suitable employment to workers with injuries

Fair Trading (Rights and Obligations of Consumers)

Do you have an understanding of the rights and obligations of consumers?

Notice Issued

Notice Number:

Description:

Status:

Any Further Notices

Notice Number:

Description:

Status:

Any Further Notices

Notice Number:

Description:

Status:

Any Further Notices

Notice Number:

Description:

Status:

Any Further Notices

Notice Number:

Description:

Status:

Any Further Notices

Notice Number:

Description:

Status:

Any Further Notices

Notice Number:

Description:

Status:

Any Further Notices

Notice Number:

Description:

Status:

Any Further Notices

Notice Number:

Description:

Status:

Any Further Notices

Notice Number:

Description:

Status:

Any Further Notices

Notice Number:

Description:

Status:

Any Further Notices

Notice Number:

Description:

Status:

Any Further Notices

Agreed Actions

Add Agreed Actions:

The PCBU agreed to undertake the following action:

Add agreed action ?

The PCBU agreed to undertake the following action:

Add agreed action ?

The PCBU agreed to undertake the following action:

Add agreed action ?

The PCBU agreed to undertake the following action:

Add agreed action ?

The PCBU agreed to undertake the following action:

Add agreed action ?

The PCBU agreed to undertake the following action:

Add agreed action ?

The PCBU agreed to undertake the following action:

Add agreed action ?

The PCBU agreed to undertake the following action:

Add agreed action ?

The PCBU agreed to undertake the following action:

Add agreed action ?

The PCBU agreed to undertake the following action:

Any Additional Comments

Any Additional Comments

Summary of Inspector Powers Exercised
I exercised my powers under the following sections of the Work Health and Safety Act 2011:
Resource Guides

Safe Work Australia, Guide to managing risks of tree trimming and removal work (2016)
http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/972/guide-to-managing-risks-tree-trimming-removal-01082016.pdf

Code of Practice -Managing the risks of falls at workplaces - (2016)
http://www.safework.nsw.gov.au/__data/assets/pdf_file/0018/50076/Managing-the-risk-of-falls-at-workplaces-code-of-practice-SW08159-0316-313930.pdf

Tree and Vegetation Management near overhead electric lines information sheet (2014)
http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/859/Tree-Vegetation-Management-OHEL-Information-Sheet.pdf

Code Of Practice – Work near overhead power lines (2006)
http://www.safework.nsw.gov.au/__data/assets/pdf_file/0020/52832/Work-near-overhead-power-lines-code-of-practice.pdf

Code of Practice – SafeWork Australia, Managing noise and preventing hearing loss at work (2015)
http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/627/Managing_Noise_Preventing_Hearing_Loss_Work.pdf

Code of Practice – Amenity Tree Industry (1998)
http://www.safework.nsw.gov.au/__data/assets/pdf_file/0009/52866/Amenity-Tree-Industry-Code-of-Practice.pdf

Guidelines for return to work programs (SIRA)
http://www.sira.nsw.gov.au/resources-library/workers-compensation-resources/publications/help-with-getting-people-back-to-work/guidelines-for-workplace-return-to-work-programs

Standard return to work program (SIRA)
http://www.sira.nsw.gov.au/resources-library/workers-compensation-resources/publications/help-with-getting-people-back-to-work/standard-return-to-work-program

Workers compensation guide for employers: when a worker is injured (SIRA)
http://www.sira.nsw.gov.au/resources-library/workers-compensation-resources/publications/workers-compensation-policies/workers-compensation-guide-for-employers

Injured at work guide (SIRA) – This guide is for injured workers.
https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=0ahUKEwiEybOkjeHRAhUHkZQKHQdrC6kQFggsMAE&url=http%3A%2F%2Fwww.sira.nsw.gov.au%2F__data%2Fassets%2Fpdf_file%2F0006%2F104289%2Finjured-at-work-guide-8097.pdf&usg=AFQjCNHx_QxWbhgp_pj9wEhvBKOVRGSV4g&sig2=eu-O3oIKqK5E_P9gSQQbcQ

Return to work assist program for micro employers – guidelines (SIRA)
http://www.sira.nsw.gov.au/workers-compensation/help-with-getting-back-to-work/assistance-for-micro-employers

Information

INTERNAL REVIEW OF CERTAIN INSPECTOR DECISIONS
If you want to apply for internal review of a decision made by an inspector during this visit, you must do so with the Governance and Appeals Unit, SafeWork NSW within, 14 days of the date the decision came to your notice or in the case of an improvement notice the lesser of 14 days or the period specified in the notice for compliance (or such longer period as the regulator allows). SafeWork NSW must conduct the internal review within 14 days (unless further information is required). If SafeWork NSW does not notify you of the internal review decision within the required time, SafeWork NSW is taken to have made a decision to affirm the reviewable decision. Not all decisions can be internally reviewed and in order to seek internal review of a decision you must be an eligible person. If you are not satisfied with an internal review decision you can apply for an external review to the Industrial Relations Commission.

Application forms for internal review, a list of reviewable decisions and a list of eligible persons are available upon request from the inspector, SafeWork NSW by telephoning 13 1O 50, or they can be downloaded from our website www.safework.nsw.gov.au.

You can contact the Governance and Appeals Unit by telephone (02) 4724 4920 or by email at reviews@workcover.nsw.gov.au.

FEEDBACK
If you want to contact SafeWork NSW in relation to this inspection by our Inspector other than for Internal Review purposes (see above), please use the following guide:
• To clarify any matter that is covered by the Inspection Report and any associated Notices or directions contact the issuing Inspector, whose name and contact details appear at the top of this Inspection Report.
• To make comment about any aspect of how this inspection was conducted, contact the inspector's senior management on telephone 13 10 50 or by writing to SafeWork NSW, Locked Bag 2906, Lisarow NSW 2252.

TO VIEW DOCUMENTS TAKEN BY THE INSPECTOR
Contact the issuing Inspector, whose name and contact details appear at the top of this Inspection Report to make an appointment.

PRIVACY COLLECTION STATEMENT
SafeWork NSW collects, uses, discloses and stores information in accordance with the Work Health and Safety Act 2011, other legislation administered by SafeWork NSW and all applicable privacy laws. This includes information collected by SafeWork NSW inspectors or authorised officers. Note that privacy laws do not apply if other laws conflict or allow or require the collection of information, and do not apply to the collection of information by SafeWork NSW to the extent that it is exercising its law enforcement functions and non-compliance with privacy legislation is deemed necessary to fulfill those functions.

SafeWork NSW privacy information is on our website at www.safework.nsw.gov.au.

FURTHER INFORMATION
SafeWork NSW has a range of publications to explain your legal responsibilities and help you make your premises/site safer. To inquire about these publications, telephone 1300 799 003 or visit our website www.safework.nsw.gov.au.

RECEIVED BY EMAIL - PRIVACY AND CONFIDENTIALITY NOTICE
The information contained in this email is intended for the named recipient(s) only and may contain privileged and confidential information and if you are not the intended recipient, you must not copy, distribute or take any action in reliance. If you have received this facsimile/email in error, please notify the sender immediately by telephone and if requested forward the original to the sender by mail. Views expressed in this message are those of the individual sender, and are not necessarily the views of the agency.

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.