Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

0.0 Introduction

  • Applicable Items
    Building Assessment - 1, 2, 6, 7, 9, 11, 12, 17, 19, 20, 24, 28, 29
    Chemical Dosing Assessment - 6, 9, 11, 12,17, 20, 24, 27, 28, 30
    Control Cubicle Assessment - 7, 11, 12, 17, 20, 28, 30
    Exposed pipework assessment - 6, 9, 12, 17, 19, 27, 28
    Pits & Manholes assessment - 6, 7, 11, 12, 17, 19, 20, 24, 26, 27, 28
    Pumps Sets assessment - 6, 12, 17, 20, 25, 27, 28
    Field Services Site assessment - Depending on site being inspected
    Storage Tank & Basins assessment - 1, 2, 9, 12, 19, 24, 26, 27
    Traralgon Office Assessment - 1, 3, 4, 5, 6, 7, 8, 10, 11, 12, 14, 20
    SORF Assessment - 3, 6, 7, 9, 17, 18, 19, 20, 24, 31

1.0 Security

  • 1.1 Perimeter fences and gates maintained and secure?

  • Corrective Action Required

  • 1.2 Facility Code & Description displayed?

  • Corrective Action Required

  • 1.3 Is the Gippsland Water logo clearly displayed?

  • Corrective Action Required

  • 1.4 Site emergency number displayed? 1800 057 057

  • Corrective Action Required

  • 1.5 Visitors are inducted onto the site? (Induction not exceeding 2 years)

  • Corrective Action Required

  • 1.6 Visitors are visibly displaying swipe cards?

  • Corrective Action Required

  • 1.7 Visitors are signed onto visitors register?

  • Corrective Action Required

2.0 Public Protection

  • 2.1 Appropriate barricading in place?

  • Corrective Action Required

  • 2.2 Appropriate signage in place?

  • Corrective Action Required

  • 2.3 Are on-site noise levels likely to cause nuisance or complaints?

  • Corrective Action Required

  • 2.4 Are dust and noise controls in place?

  • Corrective Action Required

  • 2.5 Footpaths clean and suitable for public use?

  • Corrective Action Required

  • 2.6 Appropriate traffic control measures in place?

  • Corrective Action Required

  • 2.7 Is the water extraction or discharge point clearly signed?

  • Corrective Action Required

3.0 Fire Control

  • 3.1 Fire fighting equipment is serviced and tagged within last 6 months?

  • Corrective Action Required

  • 3.2 Extinguishers are appropriately signed and easy to locate?

  • Corrective Action Required

  • 3.3 Alarm system and sprinkler system is in place and tested regularly?

  • Corrective Action Required

  • 3.4 Smoking/naked flame restrictions are observed?

  • Corrective Action Required

  • 3.5 Minimum quantities of flammables stored in work area?

  • Corrective Action Required

  • 3.6 Can anyone be injured by fire or explosion?

  • Corrective Action Required

  • 3.7 Regrowth of vegetation or plant debris build-up causing a hazard?

  • Corrective Action Required

4.0 Emergency

  • 4.1 Emergency exit signs in place and illuminated where appropriate?

  • Corrective Action Required

  • 4.2 Exit pathways are clear of obstructions?

  • Corrective Action Required

  • 4.3 Employees are aware of their muster area?

  • Corrective Action Required

  • 4.4 Emergency number displayed on or near telephone?

  • Corrective Action Required

  • 4.5 Exit doors are easily opened from inside?

  • Corrective Action Required

  • 4.6 Emergency personnel are identified and trained?

  • Corrective Action Required

  • 4.7 Emergency procedures clearly displayed?

  • Corrective Action Required

  • 4.8 Evacuation floor plans clearly displayed?

  • Corrective Action Required

  • 4.9 Alarms are tested regularly?

  • Corrective Action Required

  • 4.10 Emergency simulations are conducted?

  • Corrective Action Required

  • 4.11 Staff is aware of the emergency code for their work area?

  • Corrective Action Required

  • 4.12 Emergency Cabinet Information current?

  • Corrective Action Required

5.0 Systems of work

  • 5.1 OH&S Policy and Procedures current and available to employees

  • Corrective Action Required

  • 5.2 SHE Committee Poster displayed?

  • Corrective Action Required

  • 5.3 Employees aware of how to report incidents?

  • Corrective Action Required

  • 5.4 “Are you injured?” Poster displayed?

  • Corrective Action Required

6.0 Goods and Hazardous Substances (incl Asbestos)

  • 6.1 Is Asbestos material known to be present on site?

  • Action Required

  • 6.2 Material Safety Data Sheets available and current?

  • Corrective Action Required

  • 6.3 Chemical inventory current?

  • Corrective Action Required

  • 6.4 Chemicals stored in a safe manner and bunded appropriately?

  • Corrective Action Required

  • 6.5 Dangerous goods and hazardous substances stored in line with segregation requirements?

  • Corrective Action Required

  • 6.6 HAZCHEM signage displayed where required?

  • Corrective Action Required

  • 6.7 Adequate ventilation/exhaust systems?

  • Corrective Action Required

  • 6.8 Containers labelled appropriately?

  • Corrective Action Required

  • 6.9 PPE available and used?

  • Corrective Action Required

  • 6.10 Facilities available to ensure personal hygiene?

  • Corrective Action Required

  • 6.11 Waste procedure known and used?

  • Corrective Action Required

  • 6.12 Spill kit available and placed near bunds/chemicals/potential spills?

  • Corrective Action Required

  • 6.13 Chemical handling procedures followed?

  • Corrective Action Required

  • 6.14 Appropriate emergency/first aid equipment available?

  • Corrective Action Required

  • 6.15 Safety shower/eye wash available & working?

  • Corrective Action Required

  • 6.16 Visible chemical spills outside of bunded areas?

  • Corrective Action Required

  • 6.17 Visible waste water spills outside of bunded areas?

  • Corrective Action Required

  • 6.18 Leaking/dripping taps or valves on chemical storage vessels?

  • Corrective Action Required

  • 6.19 Exposure to chemicals, toxic gases, fumes, dust, noise, vibration, radiation, pressure, vacuum?

  • Corrective Action Required

7.0 Housekeeping

  • 7.1 Are the floors of offices and passageways, store rooms and stairways:<br>Kept free from obstruction?<br>

  • Corrective Action Required

  • 7.2 Are the floors of offices and passageways, store rooms and stairways:<br>Adequately illuminated?

  • Corrective Action Required

  • 7.3 Are the floors of offices and passageways, store rooms and stairways:<br>Clear of electrical leads?

  • Corrective Action Required

  • 7.4 Are work surfaces:<br>Safe and suitable for task?

  • Corrective Action Required

  • 7.5 Are work surfaces:<br>Clear of rubbish?

  • Corrective Action Required

  • 7.6 Are work surfaces: Tools put away?

  • Corrective Action Required

  • 7.7 Are Work Surfaces: Areas free of slip and trip hazards?

  • Corrective Action Required

  • 7.8 Are Work Surfaces: Any floor openings covered and clearly identified?

  • Corrective Action Required

  • 7.9 Are Work Surfaces: All stock and material stored safely?

  • Corrective Action Required

  • 7.10 Are Work Surfaces: Oil and grease spot wiped up?

  • Corrective Action Required

  • 7.11 Are Work Surfaces: Sawdust, shavings swept up?

  • Corrective Action Required

  • 7.12 Are Work Surfaces: Surface water drains clear of debris and no sign of damage?

  • Corrective Action Required

  • 7.13 Grounds and Site Maintenance: Grass cutting & weed control?

  • Corrective Action Required

  • 7.14 Grounds and Site Maintenance: Pest (non-native animals) & Vermin control?

  • Corrective Action Required

  • 7.15 Grounds and Site Maintenance: Is any vegetation required to be removed?

  • Corrective Action Required

  • 7.16 Grounds and Site Maintenance: Is earth moving proposed in the next 6 months?

  • Corrective Action Required

8.0 Amenities

  • 8.1 Amenities Clean?

  • Corrective Action Required

  • 8.2 Appliances Clean?

  • Corrective Action Required

  • 8.3 Clean drinking water available?

  • Corrective Action Required

  • 8.4 Rubbish and recycling bins available and are covered?

  • Corrective Action Required

  • 8.5 Visible signs of vermin?

  • Corrective Action Required

9.0 Stairs, Steps, Landings, walkways, handrails, ladders

  • 9.1 Stairs, Steps, Landings, walkways, handrails, ladders: Excessively worn or broken steps?

  • Corrective Action Required

  • 9.2 Stairs, Steps, Landings, walkways, handrails, ladders: Handrail in good repair/order?

  • Corrective Action Required

  • 9.3 Stairs, Steps, Landings, walkways, handrails, ladders: Non-slip treatment to treads?

  • Corrective Action Required

  • 9.4 Stairs, Steps, Landings, walkways, handrails, ladders: Kick plates where appropriate?

  • Corrective Action Required

  • 9.5 Stairs, Steps, Landings, walkways, handrails, ladders: Treads have liquid spilt on them?

  • Corrective Action Required

  • 9.6 Stairs, Steps, Landings, walkways, handrails, ladders: Step edge highlighted where appropriate i.e. painted yellow?

  • Corrective Action Required

  • 9.7 Stairs, Steps, Landings, walkways, handrails, ladders: Any signs of degradation (i.e. rust)

  • Corrective Action Required

  • 9.8 Stairs, Steps, Landings, walkways, handrails, ladders: Uneven surfaces, obstacles, wet or greasy surfaces

  • Corrective Action Required

10.0 Materials Storage

  • 10.1 Are stacked materials stable?

  • Corrective Action Required

  • 10.2 Sufficient space is allowed for moving items into and out of storage areas?

  • Corrective Action Required

  • 10.3 Materials are stored in appropriate areas i.e. racks, bins, etc.?

  • Corrective Action Required

  • 10.4 Storage shelves are free of rubbish and clean?

  • Corrective Action Required

  • 10.5 Pallets are in good repair?

  • Corrective Action Required

  • 10.6 Heavier items are stored at waist height?

  • Corrective Action Required

  • 10.7 Items stored are not in danger of falling?

  • Corrective Action Required

  • 10.8 Items stored do not have protruding sharp edges?

  • Corrective Action Required

  • 10.9 Safe means available for accessing high shelves?

  • Corrective Action Required

  • 10.10 Storage racks present a hazard with lights, sprinklers or fittings?

  • Corrective Action Required

11.0 Lighting

  • 11.1 Are employees able to control incoming natural light or glare sources?

  • Corrective Action Required

  • 11.2 Artificial lighting causing reflections from work surfaces or shadows over the task?

  • Corrective Action Required

  • 11.3 Light fittings clean and in good repair?

  • Corrective Action Required

  • 11.4 Flicking or inoperable lights?

  • Corrective Action Required

12.0 Ergonomics

  • 12.1 Workstation set up acceptable?

  • Corrective Action Required

  • 12.2 Ergonomic factors considered in work layout and task design?

  • Corrective Action Required

  • 12.3 Use of excessive and repetitive movements minimised?

  • Corrective Action Required

  • 12.4 Staff aware of where to seek advice regarding ergonomics?

  • Corrective Action Required

  • 12.5 Poor design or layout of facility which creates a hazard?

  • Corrective Action Required

13.0 Manual Handling

  • 13.1 Hazardous manual handling tasks been assessed and controlled?

  • Corrective Action Required

  • 13.2 Mechanical aids provided and used?

  • Corrective Action Required

14.0 First Aid

  • 14.4 First aid treatment form available?

  • Corrective Action Required

  • 14.1 Cabinets and contents clean and checked in last 12 months?

  • Corrective Action Required

  • 14.2 First aid material adequate for work area?

  • Corrective Action Required

  • 14.3 Names of trained first aider are prominently displayed?

  • Corrective Action Required

15.0 Personal Protective Equipment

  • 15.1 Appropriate PPE being worn for tasks?

  • Corrective Action Required

  • 15.2 PPE stored and maintained appropriately?

  • Corrective Action Required

  • 15.3 PPE signage is appropriately displayed?

  • Corrective Action Required

16.0 Sunsmart

  • 16.1 Recommended clothing being worn?

  • Corrective Action Required

  • 16.2 30+ sunscreen available and being used?

  • Corrective Action Required

17.0 Traffic Management

  • 17.1 Traffic flows present any hazards?

  • Corrective Action Required

  • 17.2 Vehicle parking presents any hazards?

  • Corrective Action Required

18.0 Prevention of Falls

  • 18.1 All work platforms have secure handrails and guarding?

  • Corrective Action Required

  • 18.2 Unsafe area signposted and barricaded?

  • Corrective Action Required

  • 18.3 Employees are aware of fall prevention requirements?

  • Corrective Action Required

  • 18.4 All ladders are visibly in good condition?

  • Corrective Action Required

  • 18.5 Ladders used as work platforms?

  • Corrective Action Required

  • 18.6 Ladders are securely fixed at the top and bottom?

  • Corrective Action Required

  • 18.7 Metal ladders used near live exposed electrical equipment?

  • Corrective Action Required

  • 18.8 Areas free of slip and trip hazards?

  • Corrective Action Required

19.0 Electrical equipment & Control Cubicles

  • 19.1 Broken plugs, sockets or switches?

  • Corrective Action Required

  • 19.2 Frayed or uninsulated leads?

  • Corrective Action Required

  • 19.3 Electrical equipment & appliances PETE tested tagged & current?

  • Corrective Action Required

  • 19.4 Switches/circuits identified?

  • Corrective Action Required

  • 19.5 Power tools in a visibly good condition?

  • Corrective Action Required

  • 19.6 Work being conducted near exposed live electrical equipment?

  • Corrective Action Required

  • 19.7 Strained leads?

  • Corrective Action Required

  • 19.8 Lock out procedures and danger tags used where appropriate?

  • Corrective Action Required

  • 19.9 Earth leakage devices used?

  • Corrective Action Required

  • 19.10 Start/Stop switches clearly identified?

  • Corrective Action Required

  • 19.11 Switchboards secured?

  • Corrective Action Required

  • 19.12 Visible signs of vermin?

  • Corrective Action Required

  • 19.13 Control Cubicles: Are control cubicles secure?

  • Corrective Action Required

  • 19.14 Control Cubicles: Adequate signage to draw attention to potential hazard?

  • Corrective Action Required

20.0 JSEA & Job Start

  • 20.1 JSEA and Job Start books available and being completed?

  • Corrective Action Required

  • 20.2 Hot Work Permits completed?

  • Corrective Action Required

21.0 Lifting Equipment

  • 21.1 All portable lifting equipment tested and tagged?

  • Corrective Action Required

22.0 Confined Spaces

  • 22.1 Confined Space Permits completed correctly?

  • Corrective Action Required

23.0 Pits and Manholes

  • 23.1 Correct signage in place?

  • Corrective Action Required

  • 23.2 Pit or Manhole structurally sound?

  • Corrective Action Required

  • 23.3 Covers & lids in good condition?

  • Corrective Action Required

  • 23.4 Covers & lids prevent unauthorised access to pit or manhole?

  • Corrective Action Required

  • 23.5 Free of pests & vermin?

  • Corrective Action Required

  • 23.6 Ventilation adequate for normal operations?

  • Corrective Action Required

  • 23.7 Ventilation sufficient to prevent asset damage?

  • Corrective Action Required

24.0 Pumps

  • 24.1 Leaks?

  • Corrective Action Required

  • 24.2 Are pumps in good operating order?

  • Corrective Action Required

25.0 Storage Tanks ,Basins & pits

  • 25.1 Adequate barriers, guard rails & signage to prevent falling?

  • Corrective Action Required

  • 25.2 Non-slip walkways fitted to floating basin covers?

  • Corrective Action Required

  • 25.3 Tank or basin in good condition?

  • Corrective Action Required

  • 25.4 Covers & lids in good condition?

  • Corrective Action Required

  • 25.5 Covers & lids prevent unauthorised access?

  • Corrective Action Required

  • 25.6 Is it possible for a person to enter a storage pit without authorisation?

  • Corrective Action Required

  • 25.7 Storage freeboard level maintained to prevent over-topping?

  • Corrective Action Required

  • 25.8 Observable signs of leakage or seepage?

  • Corrective Action Required

  • 25.9 Algae present in lagoon or basin?

  • Has algae type been identified and risks communicated?

  • Any Further Action Required?

  • Corrective Action Required

  • 25.10 Potential damage to lagoon walls (e.g. erosion, vegetation)?

  • Corrective Action Required

26.0 Exposure to raw sewerage/contaminated water

  • 26.1 Is there potential for exposure to raw sewerage/contaminated water?

  • Corrective Action Required

27.0 Damage to Assets

  • 27.1 Is there potential for accidental/deliberate damage to assets?

  • Corrective Action Required

28.0 Structural Integrity of Building

  • 28.1 Can the structural condition of buildings contribute to a hazard?

  • Corrective Action Required

29.0 Incorrect Use of Controls

  • 29.1 Can controls be incorrectly used resulting in asset damage?

  • Corrective Action Required

30.0 Extremes of Temperature

  • 30.1 Can anyone come into contact with objects at high temperature?

  • Corrective Action Required

  • 30.2 Can anyone suffer ill health due to high or low temperature?

  • Corrective Action Required

31.0 Powerlines and powerpoles

  • 31.1 Serial numbers provided and clearly shown for power poles located onsite

  • Corrective Action Required

32.0 Environmental Management

  • 32.1 Have there recently been uncontrolled discharges to the environment beyond the site boundary (e.g. odour, chemicals, water, wastes)?

  • Have actions required been completed?

  • Further actions required?

  • 32.2 Have there been any recent complaints regarding noise, odour, air emissions, water, waste?

  • Have actions required been completed?

  • Further actions required?

  • 32.3 Natural water bodies and lagoons fenced from access by livestock?

  • Corrective Action Required

  • 32.4 Bank erosion or visible contamination of waterways?

  • Corrective Action Required

  • 32.5 Waste generated on-site transferred to a waste or recycling facility?

  • Corrective Action Required

  • 32.6 Are portable monitoring devices being calibrated as required?

  • Corrective Action Required

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.