Health, Safety & Environmental Inspection Report

• Contract

  Select

• Contract number

• Location
  Address

• Date & Time

  Date

• Site Manager

• Signature

  Sign

• Auditor

• Signature

  Sign

• Work being carried out at time of inspection

• Number of men on site: Manager/Engineer/Plant Operative/Labourer etc.

• Site Managers

• Engineers

• Plant Operators

• Other

  Yes

  No

• Please state who is on site.

Incident Stats to date

• Major Injury

  Select 0 1 2 3 4 5 6 7 8 9 10+

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10+

• Lost Time >7 day

  Select 0 1 2 3 4 5 6 7 8 9 10+

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10+

• Lost Time <7 day

  Select 0 1 2 3 4 5 6 7 8 9 10+

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10+

• Minor Injury

  Select 0 1 2 3 4 5 6 7 8 9 10+

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10+

• First Aid Treatment

  Select 0 1 2 3 4 5 6 7 8 9 10+

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10+

• Near Miss

  Select 0 1 2 3 4 5 6 7 8 9 10+

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10+

• 1. Induction (including all operatives signed onto RAMS)

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 2. Access

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 3. Demolition

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• 4. Excavation

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 5. Lifting Operations

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• 6. Plant/Machinery

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 7. Portable Tools

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• 8. Electricity/Gas

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• 9. Guard/Fencing

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• 10. Scaffolding

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• 11. PPE

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 12. Fire Precautions

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 13. Environmental

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 14. Health & Welfare

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 15. Asbestos

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 16. Site Cleanliness

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 17. Health & Safety Plan

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 18. Registers/Tool Box Talks

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 19. Method Statements

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

Signatures

• Are they signed by all on-site personnel?

  Yes

  No

  N/A

• Give details

• 20. Statutory Notices

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• 21. Accident Book/First Aid

  Compliant

  Non-Compliant

  N/A

  Principal Contractor

  Action

• Give details

• 22. Permit to Work

  Compliant

  Non Compliant

  N/A

• Give details

• 23. Permit to Dig

  Compliant

  Non Compliant

  N/A

• Give details

• 24. Waste Carriers Licence

  Compliant

  Non Compliant

  N/A

• Give details

• Have the DAB's been completed daily as specified since last visit?

  Yes

  No

  N/A

• Is there evidence of the meetings? (i.e. Sign off sheets, Minutes, etc.)

  Yes

  No

  N/A

Equipment

• Make & Model

• Plant/Serial Number

• Contractor

  TKL

  Other

• Please state Contractor

• Certificates of inspection

  Compliant

  Non Compliant

  N/A

• Evidence of Daily Checks

  Compliant

  Non Compliant

  N/A

• Confirmation of Operator Competence

  Compliant

  Non Compliant

  N/A

• Machine Operator

• Are there any issues for Safety, Health, Environmental or Quality during this audit?

  Yes

  No

  N/A

• Give details below

Identified safety issues

• undefined

Identified health issues

• undefined

Identified environmental issues

• undefined

Identified quality issues

• undefined

• Are POL Points safe and not impacting the environment?

  Safe

  At Risk

  N/A

• Give details

• Are Spill Kits available and easily accessed?

  Yes

  No

  N/A

• Give details

• Are there any actions from the previous audit?

  Yes

  No

• Item

• Comments

• Are there any actions from this audit?

  Yes

  No

• Item

• Comments

• Have you identified any very good practice during this audit?

  Yes

  No

  N/A

• Item

• Comments

• Item

• Comments

Overall Evaluation

• Findings

• Status

  Compliant

  Non Compliant

  Opportunity For Improvement

  Not Applicable

• Add media

  Media