Gull - TNZ Higher Risk Work Activity Checklist

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Work type classifications

Work at height

• Work at height

  Yes

  Not applicable

• Work at height permit completed

  Yes

  No

• Risk assessment/Job Safety Analysis completed for task

  Yes

  No

• Ladders/scissor lifts/boom arms/cherry pickers within certification

  Yes

  No

  N/A

• Is the ground surace on which the eqipment will be used firm & even

  Yes

  No

  N/A

• Ropes/harnesses in good condition and within certification period

  Yes

  No

  N/A

• Carabiners if used are auto locking and triple action design

  Yes

  No

  N/A

• Fall protection equipment selected to enable self help/rescue

  Yes

  No

  N/A

• Anchor points identified and fit for purpose

  Yes

  No

  N/A

• Effective work at height rescue plan in place

  Yes

  No

  N/A

• Area below where work at height is being undertaken is secured from unauthorised entry

  Yes

  No

  N/A

• Weather issues considered

  Yes

  No

  N/A

• Scaffolding erected by certified scaffolder and tagged suitable for use

  Yes

  No

  N/A

• Scaffolding erected > 6metres away from live power lines

  Yes

  No

  N/A

Confined space

• Confined space

  Yes

  Not applicable

• Confined space permit completed

  Yes

  No

  N/A

• Risk assessment / Job SafetyAnalysis completed for task

  Yes

  No

  N/A

• Gas detector within calibration perion and bump tested before use

  Yes

  No

  N/A

• Work site visited before permit issued

  Yes

  No

  N/A

• Ventilation requirements in confined space identified

  Yes

  No

  N/A

• Oxygen levels in confined space between 19.5 to 23.5%

  Yes

  No

  N/A

• Toxic gases that could be present (carbon monoxide; hydrogen sulphide; nitrogen dioxide) are all below the detector alarm levels

  Yes

  No

  N/A

• Pipes/vents/shutes/ducts etc. connected to the confined space are isolated (physical disconnection, blanking, spading, block & bleed)

  Yes

  No

  N/A

• Contractor's and clients locks and tags have been placed on all isolation valves and switches

  Yes

  No

  N/A

• Rotating equipment has been imobilised, isolated and secured

  Yes

  No

  N/A

• In silos, the risk of slumping or product movement has been addressed

  Yes

  No

  N/A

• A Safety Observer has been assigned

  Yes

  No

  N/A

• There is a clear means of communication between the Safety Observer and workers

  Yes

  No

  N/A

• All parties aware of signal/sign of an emergency

  Yes

  No

  N/A

• Effective confined space emergency rescue plan developed

  Yes

  No

  N/A

• Contact details of emergency services documented and readily available

  Yes

  No

  N/A

• Gas cylinders in use?

  Yes

  No

• Gas cylinders (other than self contained breathing apparatus) kept outside confined space

  Yes

  No

  N/A

• Gas hoses inspected and in good condition

  Yes

  No

  N/A

• Gas hoses removed from confined space during breaks and end of work shift

  Yes

  No

  N/A

• Gas readings taken before entry and monitored on continious basis and recorded at perscribed frequency

  Yes

  No

  N/A

Hot work within hazardous zone

• Hot work within hazardous zone

  Yes

  Not applicable

• Hot Work permit completed

  Yes

  No

  N/A

• Work site visited before permit issued

  Yes

  No

  N/A

• Risk assessment / Jobe Safety Analysis completed for task

  Yes

  No

  N/A

• Gas detector within calibration perion and bump tested before use

  Yes

  No

  N/A

• Lower Explosive Limit (LEL) of work area below alarm level

  Yes

  No

  N/A

• Hot work being undertaken in confined space?

  Select Yes Not applicable

  • Yes
  • Not applicable

• Hot work + confined space ... oxygen must be between 19.5% and 23.5% and if >20% LEL = no entry; 11 to 20% LEL = entry with breathing apparatus for observation only; 2 to 10% LEL = entry with breathing apparatus for cold work only; <2% LEL = normal entry for hot work.

• Conditions for hot work in confined space satisfied?

  Yes

  No

  N/A

• Gas readings taken before entry and monitored on continious basis at the point hot work is being undertaken and recorded at perscribed frequency

  Yes

  No

  N/A

• Drains and gutters within 15 metres of hot work site considered and covered and/or blocked

  Yes

  No

  N/A

• Fire Watch person identified

  Yes

  No

  N/A

• Fire extinguishers available at point where hot work is being undertaken

  Yes

  No

  N/A

• Product in pipes/vessels/tanks leading to and from hazardous areas have been considered and made safe

  Yes

  No

  N/A

• Is hot work is to be undertaken on pipework/vessels/tanks?

  Select Yes Not applicable

  • Yes
  • Not applicable

• Have pipes/vessels/tanks been fully degassed?

  Yes

  No

  N/A

• Pipes leading into and out of vessels/tanks or connected to pipework to be worked on have either been - fully disconnected, flanged and isolated; double blocked with open bleed; spaded

  Yes

  No

  N/A

• All combusible materials have been removed from the work area

  Yes

  No

  N/A

• Non-flammable protective screens are in use

  Yes

  No

  N/A

• Requirement for Fire Watch to remain at worksite for at least 30 minutes after completion of hot work

  Yes

  No

  N/A

Excavation - ground penetration

• Excavation - ground penetration

  Yes

  Not applicable

• Excavation - Penetration work includes i) Insertion of metal spikes >230mm ii) Hand excavations >230mm iii) Machine excavationusing powered plant or pnumatic drilling >150mm iv) Any machine excavations irrespective of depth.

• Investigation undertaken to determine layout of undergrond cables, pipes, drains, and services

  Yes

  No

  N/A

• Emergency contact numbers of utility services known

  Yes

  No

  N/A

• If excavation classified as 'notifiable' (i.e. excavation >1.5meres deep & is deeper than it is wide, any form of tunnel work, excavations where excavated face >5 metres deep & batter of face is steeper than 1 horizontal to 2 vertical) regulator has been informed?

  Yes

  No

  N/A

• Effective emergency exit established for major excavations

  Yes

  No

  N/A

• Lone worker restrictions have been applied

  Yes

  No

  N/A

• Soil type structure considered for all trench work and excavations

  Yes

  No

  N/A

• Toxic &/or explosive gas issues considered

  Yes

  No

  N/A

• Where excavators are in use, swing area of excavator's boom arm are cordoned off to prevent unauthorised access into swing area/crush zone

  Yes

  No

  N/A

• Water run-off has been considered

  Yes

  No

  N/A

• Excavation area inspected after major rainfall

  Yes

  No

  N/A

• Positioning of heavy equipment >0.6 metres from excavation which has been battered to safe slope

  Yes

  No

  N/A

• During excavation , soil heaps are positioned >0.6 metres from battered safe slope

  Yes

  No

  N/A

• Excavations are adequately guarded & marked or covered to prevent personnel or members of the public falling into the area

  Yes

  No

  N/A

• Emergency plans are in place

  Yes

  No

  N/A

Work involving high energy sources

• Work involving high energy sources

  Yes

  Not applicable

• All options for de-energising the equipment have been exhausted?

  Yes

  No

  N/A

• Where de-energising of the equipment is not possible, effective isolation practices have been adopted

  Yes

  No

  N/A

• A formal risk assessment has been undertaken which included a technically competent person in the review team

  Yes

  No

  N/A

• Controls are established to manage identified hazards to a level that are 'As Low As Reasonably Practicable (ALARP)'

  Yes

  No

  N/A

• The controlled (residual) risk level following the application of controls is acceptably low that the task can be undertaken safely

  Yes

  No

  N/A

• All energy sources and the means of their de-energisation and/or isolation have been communicated to all members of the work group (e.g. via 'toolbox' meetings)

  Yes

  No

  N/A

• Dependant upon the risk profile of the work being planned/undertaken, the appropriate level of supervisor/managerial sign-off has been obtained

  Yes

  No

  N/A

• Examples of high energy sources that should be considered (but not limited to) include - electrical; pressure; hydraulic; objects at height; x-ray; laser; ionising and non-ionising radiation; noise; vibration; kinetic (moving or rotating equipment/objects); mechanical; thermal et.

Work involving toxic and/or hazardous material(s)

• Work involving toxic and/or hazardous material(s)

  Yes

  Not applicable

• Personnel technically competent and familiar with the toxic &/or hazardous material(s) have been involved in preparing a risk assessment/Job Safety Analysis for the task

  Yes

  No

  N/A

• Incompatable materials are known & eliminated from the work area

  Yes

  No

  N/A

• A current safety data sheet (<5 years old) is available and has been referenced in the risk assessment process

  Yes

  No

  N/A

• The signs & symptoms of exposure to the toxic/hazardous materials are known and communicated to all members of the work group

  Yes

  No

  N/A

• First Aid resources and a qualified First Aider are available to respond to an exposure to the toxic/hazardous material(s)

  Yes

  No

  N/A

• Contact numbers for emergency services are known and available

  Yes

  No

  N/A

• Equipment/tankage/pipework containing the toxic/hazardous material(s) have been decontaminated to a level where they no longer pose a threat to the work group

  Yes

  No

  N/A

• Where full decontamination of equipment/tankage/pipework has not been been possible, this must be clearly communicated to all members of the work group and an assessment must be made as to whether it is safe to proceed with the task and if additinal controls are required.

• Pipes leading into and out of vessels/tanks or connected to pipework to be worked on have either been - fully disconnected, flanged and isolated; double blocked with open bleed; spaded

  Yes

  No

  N/A

• Contractor's and clients locks and tags have been placed on all isolation valves and switches

  Yes

  No

  N/A

• Correct personal protective equipment (PPE) is worn and in good condition

  Yes

  No

  N/A

• Facilities for the decontamination of PPE and equipment available

  Yes

  No

  N/A

• Facilities available for the disposal of contaminated waste streams

  Yes

  No

  N/A

Heavy lifts

• Heavy lifts

  Yes

  Not applicable

• Personnel technically competent and familiar with heavy lifts have been involved in preparing a risk assessment/Job Safety Analysis for the task

  Yes

  No

  N/A

• A heavy lift plan has been developed and approved by technically competent personnel

  Yes

  No

  N/A

• Heavy lifts are not undertaken over unprotected operational pipelines

  Yes

  No

  N/A

• Contact numbers for emergency services are known and available

  Yes

  No

  N/A

• Potential impacts within the swing radius of a crane's boom arm has been considered

  Yes

  No

  N/A

• All personnel are kept clear of the potential 'fall zone'

  Yes

  No

  N/A

• If required, has the heavy lift been notified to regulatory authorities

  Yes

  No

  N/A

• Weather conditions considered

  Yes

  No

  N/A

• Ground conditions and stability considered

  Yes

  No

  N/A

• Lifting equipment selected for task is fit for purpose and within certification

  Yes

  No

  N/A

• Operator of lifting equipment is qualified

  Yes

  No

  N/A

• Watch person nominated

  Yes

  No

  N/A

Disengagement of safety critical devices

• Disengagement of safety critical devices

  Yes

  Not applicable

• Senior Management at the facility have been advised (both verbally and written) that a safety device (or devices) will be deactivated

  Yes

  No

  N/A

• Technically competent personnel familiar with the facility and processes for which the deactivated safety critical device applies are involved in preparing a formal 'Management of Change' and risk assessment

  Yes

  No

  N/A

• If required, regulatory autorities and/or emergency services are advised of the temporary disarming of a safety critical device (or devices)

  Yes

  No

  N/A

• If alarms have been deactivated, alternate means for raising the alarm are implimented

  Yes

  No

  N/A

General considerations

• Consideration has been given of any conflicting activities being undertaken in the surrounding work area

  Yes

  No

• Person in Charge of the worksite is clearly identified

  Yes

  No