Title Page
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Client / Site
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Project Name
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Project Number
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Contractor Supervisor's Name
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Conducted on (Date and Time)
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Prepared by
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Location
Work Overview
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Number of contractors
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Description of work
Contractor Documents Reviewed
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Contractor certification & licenses
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Public liability insurance
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Professional indemnity insurance
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Workers compensation/ personal accident insurance
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Plant / equipment certification / registration
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Safe work methods, procedures, instructions for work
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Safety Data Sheets (SDS) for all hazardous chemicals to be used
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Completed Permits to Work (PTW)
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Lockout/tag out procedures
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Traffic/ environmental/ site management plan
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Site plans and services reviewed where digging / trenching will be completed
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Communication procedures in place for remote/rural/ in isolation work
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Are there any other documents reviewed?
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Please specify
Induction Checklist
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WHS Policy
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Site rules (Mandatory PPE, drugs, alcohol, smoking, etc.)
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Site emergency evacuation procedures
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Site first aid/ medical emergency procedures
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Incident reporting and investigation process
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Site sign-in / sign-out register
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Overview of general access and restricted access areas
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Overview of site hazards including those from work on site
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Risk control requirements (Hazardous chemicals, plant, equipment, excavation, confined space work, etc.)
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Site amenities and facilities
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Site parking arrangements
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Sub-contractor management processes
Completion
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Recommendations
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I have been provided with and understand the information (as indicated above) and will comply with the safety instructions listed.
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Contractor (Name and Signature)
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Click + to add sub-contractor
Sub-contractor
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Name and Signature of sub-contructor
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Role
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Company Name
