Title Page

  • Program Name

  • Reason for visit

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Pre-site checks

Pre-site checks

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

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

  • Have you completed a SWP if needed<br>

  • Have you checked the property/surrounds risk information

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 wearing the correct PPE

Site Assessment - Part 1

Site Assessment

  • Is access control effective, no unauthorised access

  • Has the Hazard/Risk Register board been updated today

  • Is the Hazard/Risk Register board in place

  • Record: If personnel on site to see if they are aware of risks on risk register
    record and compliment if induction or verbal communication of risks

  • Are the PPE requirements displayed

  • Is signage in place and appropriate for risk (e.g. report to site office, no entry, asbestos, danger)

Site Assessment - Part 2

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

  • PPE and manual handling Section

  • Are all workers wearing correct PPE

  • 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

  • If work is being conducted within 4m of overhead power lines is effective isolation in place (e.g. power disconnection, sleeving, or close approach consent).

  • Scaffolding Section

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

  • If the scaffolding exceeds 5m in height has WorkSafe been notified (does not apply if single storey home)<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 (e.g. soleboards 500mm x 200mm x 38mm thick, base boards, platforms, toe boards, stabilising legs, stand offs, gates, ladder attachments, edge protection installed effectively)

  • 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 and leads in good working order

  • Are leads used in a safe manner

  • Tools & Machinery Section

  • Are power tool tags valid

  • 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

  • Is waste from any dust extraction system disposed of safely

  • Is correct PPE for cutting activities worn (e.g. ear protection, eye protection, P2 dust mask)

  • Are lead test results on site

  • Are lead containment controls sufficient and in good condition (e.g. plastic sheeting ground cover, sealed openings) <br>

  • Is HNZ permitted method used for lead based paint removal (chemical stripping, wet scraping, wet hand sanding) <br>

Summary

Actions completed at site

    Positive Observation
  • Opportunity for Improvement Corrective Action General Comments
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