Title Page

  • Document No.

  • Audit Title

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Pre-site checks

Pre-site checks

  • Have you checked the CRIP rating - if the property is tenanted

  • Have you checked the property/surrounds risk information

  • Have you completed a SWP if needed<br>

  • Have you arranged the visit as per established protocols and notified others

Self Assessment

Self assessment and Situational Awareness

  • Is my Secure Locate activated

  • Is it safe to exit my vehicle

  • Is the site secure and safe to enter

  • Am I inducted to this site

  • Am I wearing the correct PPE

Site Assessment - Part 1

Site Assessment Mandatory Section

  • Is fencing installed to prevent access to site

  • Is access control effective, no unauthorised access

  • Is "Sign in and out" system in place

  • Is the Hazard/Risk Register board in place

  • Has the Hazard/Risk Register board been updated today

  • Are the PPE requirements displayed

  • Are "No Entry" signs in place

  • Is a "Report to site office" sign in place

  • Are "Danger" signs in place and appropriate for risk (e.g. asbestos)

  • Is induction offered to me

  • Are the risks on site described

  • Do the risks mentioned match the Hazard/Risk Register board

  • Are PPE requirements described

  • Is my induction recorded

Site Assessment - Part 2

Site Assessment Optional Section depending on activities on site/to be targeted

  • Emergency Equipment Section

  • Is a fire extinguisher available

  • Is the first aid kit complete and available

  • Is a spillage kit on site

  • Are risk specific Emergency Response Plans available and easy to access

  • Are emergency numbers available and easy to access

  • Documentation Section

  • Are clearance certificates on site e.g. asbestos, methamphetamine

  • Is a SSSP available on site

  • Are safety meeting minutes added to SSSP

  • Is the SSSP in daily use

  • Is SSSP content known on site

  • Are SDS available and easy to access

  • If asbestos being removed, is an Asbestos Removal Control Plan at site and being followed

  • If a Traffic Management Plan is in place, is it being followed

  • Site housekeeping and facilities Section

  • General site tidy and orderly, free of trip hazards

  • Are materials stacked safely

  • Are materials damaged beyond use (chemical decon only)

  • Are stacking areas demarcated

  • Are hazards demarcated (e.g. trenches)

  • Are waste materials stored in bins

  • Are waste materials sorted for recycling

  • Are bins used for hazardous materials lined

  • Are bins marked correctly

  • Are toilet facilities and running water accessible on site

  • Are exposed reinforcing bars capped

  • Personnel on site Section

  • ID tags carried and current

  • Supervisor or designated backup available on site during visit

  • PPE and manual handling Section

  • Are requirements known on site

  • Are all workers wearing correct PPE

  • Are there clean/contaminated areas for PPE on/off and cleaning

  • Are acceptable manual handling methods being used for tasks observed

  • Working at Height Section

  • Has the most appropriate equipment been chosen for work at height e.g. scaffolding, mobile scaffolding, elevated platform, ladder

  • Confirm no elevated work within 4 m of powerline

  • Scaffolding Section

  • Is edge protection installed effectively

  • Is the tag valid (present, weekly inspection recorded, completed in full)

  • If the scaffolding exceeds 5m in height has WorkSafe been notified<br>

  • If the scaffolding exceeds 5m in height has it been erected by a holder of a current certificate of competence

  • Is scaffolding installed to standard (incl. base boards, platforms, toe boards, stabilising legs, stand offs, gates, ladder attachments)

  • Ladders Section

  • Is the ladder set up at 1:4 ratio (1m horizontal to 4m vertical)

  • Can users maintain 3 points of contact at all times

  • Is the ladder secured at top and base to prevent slipping sideways/out

  • Do all ladders have more than 3 steps

  • Power Supply Section

  • Are safety devices in place

  • If power isolated is a lock out device in place with tag

  • Have power source (e.g. distribution box) leads been tagged

  • Are tags valid

  • Do leads appear to be in good working order

  • Are leads used in a safe manner

  • Electrical Equipment Section

  • Are power tools tagged

  • Are tags valid

  • Do the power tools appear to be in good working order

  • Tools & Machinery Section

  • Are safety devices operable i.e. not tampered with

  • Are the right tools or machinery being used for the job

  • Are all dangerous parts guarded

  • Do all tools and machinery appear to be in good working order

  • Hazardous Substances Section

  • Is dust control in place at source for respirable dust and/or paint particles e.g. timber, silica, lead based paint

  • Are lead test results on site

  • Is plastic sheeting in place for lead based paint removal <br>

  • Is HNZ permitted method used for lead based paint removal (chemical stripping, wet scraping, wet hand sanding, low-temperature heat processes (under 200°c))<br>

Summary

Positive Observations

  • Add media

Opportunities for improvement

  • Add media

Actions completed at site

  • Add media

Agree future/corrective actions

  • Add media

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.