Information

  • Document No.

  • Audit Title

  • Client/Site

  • Conducted on

  • Prepared by

  • Location
  • Please select Crew Leader, or

  • Contractor

  • Please enter the job's Mat. Code (for eg QAD, QBF, QBW, QAG ...)

1. Site Risk Management

  • Are relevant SWMS available and a Site Risk Assessment (JSEA) been completed?

  • Have all personnel, sub-contractors and site visitors been inducted onto the site and signed onto the JSEA?

  • Has the JSEA identified site specific Safety and Environmental risks?

  • Are all identified risk control measures on SWMS and JSEA in place?

  • Has the Traffic / Pedestrian Management Plan been identified / created and available on site and documented on the JSEA?

2. Environment & Hazardous Goods

  • If pipe bedding material and quarry product/s are stored onsite, have they been placed in a suitable location?

  • Are there effective erosion, sediment controls and / or silt traps in place?

  • Are there any chemicals in use and is there a current MSDS available for the chemical?

  • Are hazardous materials and dangerous goods separately stored and labelled?

  • Is refuelling of equipment in line with EMP section 14.11d?

  • Are there any control measures to manage spills and leaks? (ie.spill kit)

  • Have Amenity trees been adequately protected during works (ie. no signs of damage)?

  • Has due care and attention been given to excavations beneath the drip lines of any trees?

  • Is material containing Asbestos treated as per EMP and VWCA 2007 OHS regulations?

  • Has waste been segregated for reuse / recycle / disposal as per EMP section 14.10?

  • Is Waste Water treated and disposed of as per EMP section 14.9? (e.g. Syphon, Trench, Pit water)

  • Is Mains dust disposed of as per EMP section 14.3?

  • Has flora, fauna and culture heritage issues been identified and controlled as per EMP section 14.4?

3. Skills and Competency

  • Do all personnel have MG Passports on site?

  • Is all training and are all authorisations current for the functional role of the Passport holder?

  • Are all personnel trained licensed / registered for their functional role?

4. Forms/Documentation

  • Is an ipad available onsite and can personnel find relevant documents within?

  • Does the job file contain a daily job sheet / work instruction?

  • Does the job file contain current Dial before You Dig information?

  • Does the job file contain a sequence of operations?

  • Does the job file contain design drawings?

  • Are up to date district plans on site?

  • Are the latest MG Standard Work Procedures (SWP) and Engineering standards available onsite?

  • Is a Pipelines work permit required and are there any restrictions?

  • Is a Pipeline Inspector on site (if required)?

  • Is a hot work permit required and are there any hot work restrictions?

  • Is a Confined Space permit required and are crew members involved in CSE signed onto the permit?

  • Is a Road Opening Permit required and is it on site?

  • Has notice of intention to excavate been submitted to Worksafe?

5. Traffic and Pedestrian Management

  • Has the appropriate Traffic and Pedestrian Management Plan been identified, and does it meet all requirements?

  • Does the actual traffic / pedestrian layout reflect the Traffic / Pedestrian Management Plan?

  • Is pedestrian traffic safely controlled through the worksite?

  • Are traffic signs and devices legible and undamaged?

  • Are suitable barriers provided to protect the public from the work site?

  • Where site is to be left overnight, are adequate protection measures, lighting and night guidance provided?

6. Personnel Protective Equipment

  • Is PPE in accordance with Comdain requirements and task specific PPE worn as per MG U PR 0006 as a minimum?

  • Is required PPE within inspection or replacement dates and in good condition?

  • Is other appropriate PPE utilised as required and in good condition? (e.g. Harness, Life lines etc.)

7. Vehicles/Plant

  • Are all plant operators licensed as required?

  • Have pre-start checklists been completed?

  • Are all vehicles/plant within their service range?

  • Are all vehicles/plant in acceptable condition, in terms of cleanliness, and is appropriate MG branding visible?

8. First Aid

  • Is there an intact First Aid kit and are contents in good condition & within expiry dates?

  • Is the kits location marked on the vehicle?

9. Tools and Equipment: Testing and Condition

  • Is fire extinguisher charged and within test dates?

  • Are all electrical items tagged and within their test date range?

  • Is Poly Fusion equipment within the 6 month calibration cycle, gauges and teflon plates in good condition?

  • Is the gas detector calibration within the stipulated date/s (as per MG Eng Std EC-DD-4142) and stored appropriately to prevent damage?

  • Are Data Logger gauges within calibration date and stored appropriately to prevent damage?

  • Is the voltage tester fit for purpose and tested prior to use?

  • Is Washington pressure tester in good condition and stored appropriately to prevent damage?

  • Is Oxy acetylene equipment in good condition and within test date? (AS 4839 section 8)

  • Are the gas bottles within expiry date and stored appropriately?

  • Is lifting equipment in good condition and within test date?

  • Is the percussion bar and mat in good condition and within test date?

10. Worksite/Work Practices

  • Are there an appropriate number of trained and competent crew members on site for task?

  • Are Effective Safety Observers in place?

  • Are No-Go Zones being adhered to?

  • Has pipework been tested for stray current?

  • Are cross bonding leads required and used?

  • Are the appropriate numbers of fire extinguisher/s on site and placed in appropriate locations?

  • Is Plant and equipment appropriately set up?

  • Have other authority assets been located and / or exposed by hand prior to mechanical excavation?

  • Are all gas grid materials approved by Multinet?

  • Are all gas grid materials and pipe stored to prevent damage or deterioration (refer MG Eng Std ES DD 4081)?

  • Are jointing techniques in line with MG SWPs?

  • Have MG standards (including covers, clearances, offsets and bedding materials) been maintained?

  • Are stop off of Mains and Services methods in line with MG SWPs?

  • Is the site tidy with no obvious tripping or other hazards?

  • Are trenches appropriately benched, battered or shored?

  • Is spoil placed in excess of 0.5 from excavation wall?

  • Is a ladder or steps used to access excavation?

  • Is confined space rescue equipment on site and set up as required?

  • Are pits / man holes protected to prevent falls?

  • Is Sleeve / Slabbing / tape protection in place?

  • Has pressure testing and purging been conducted in line with MG SWPs?

  • If required, was a red card left with correct information and details?

  • Are valve covers, pits etc. appropriately installed and level?

11. Facilities & Compounds

  • Is crush rock laid, level and compacted?

  • Is there any evidence of subsidence in compound and around entry exit points?

  • Is the interior of compound clear of fire hazards and tidy?

  • Is the exterior of compound clear of fire hazards and tidy?

  • Is fire protection in place? Are fire extinguishers in place and within test dates?

  • Is there acceptable security of compound fence and gates?

  • Is there paint work on buildings, posts and bollards etc.?

  • Are warning signs and emergency contact details in place with current information?

  • Are PPE signs in place?

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.