Higgins Contractors Ltd.

• Document No.

• Client / Site

• Contractor:

• Type of work/activity:

• Conducted on

  Date

• Prepared by

• Location
  Address

• Is Site Attended?

  Yes

  No

  N/A

OBSERVED:

• Has daily site brief and hazard ID been done?

  Yes

  No

  N/A

• Is the 5m rule or alternative plan being applied?

  Yes

  No

  N/A

• Are controls in place for overhead and underground services?

  Yes

  No

  N/A

• Is the traffic management set out correctly?

  Yes

  No

  N/A

• Are the required environmental controls in place?

  Yes

  No

  N/A

• Are seat belts being worn by all plant operators?

  Yes

  No

  N/A

• Have all sub-contractors/visitors signed the Hazard ID sheet?

  Yes

  No

  N/A

• Is the work site clean and tidy?

  Yes

  No

  N/A

• Are excavations protected and safe?

  Yes

  No

  N/A

• Are permit to work activities being carried out as required?

  Yes

  No

  N/A

• Is the correct PPE being worn?

  Yes

  No

  N/A

• Is the quality of work achieved of an acceptable standard?

  Yes

  No

  N/A

OTHER ITEMS:

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• Item 2:

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