Information

  • Site conducted

  • PGSR Project No. and Name

  • Client Company

  • Client Office Address / Location:
  • Client Representative Name

  • Contact Mobile No.

  • Conducted on

  • Conducted By

Project Site Details

  • Name of Site

  • Address

Commitment and policy: Health & Safety Issue

  • 1. Has the host employer appointed a management representative? (Senior manager responsible for ensuring safety is managed properly)

  • Pleas provide the Senior Manager's name

  • 2. Has the management representative undergone any workplace health and safety training?

  • Please provide a copy of their competency

  • 3. Does the host employer have documented workplace health and safety policy?

  • Please provide a copy for PGSR records

  • 4. Does the host employer have documented workplace health and safety responsibilities?

  • Please provide a copy for PGSR records

  • 5. Does the host employer have documented consultation procedures?

  • Please provide a copy for PGSR records

Planning: Health & Safety Issue

  • 1. Does the host employer have a safety plan that clearly identifies objectives (e.g. eliminate injuries caused by grinders) relating to the clients industry/business?

  • Please provide a copy for PGSR records

  • 2. Has the safety Plan been reviewed with last 12 months or otherwise current?

  • 3. If there is a safety plan, do the objectives have timeframes and are resources, personnel and responsibilities allocated?

  • When will this be updated?

  • 4. Does the host employer have hazard identification and risk assessment procedures?

  • Please provide a copy for PGSR records

  • 5. Does the host employer have in place a documented process to control major workplace hazards, such as plant, electricity, Confined Spaces, Working at Hieghts and hazardous substances?

  • Please provide a copy for PGSR records

  • 6. Does the host employer manage risks consistent with the 'hierarchy of control'? (i.e. eliminating, substituting, isolating, engineering and administrative & PPE)

  • Please provide a copy for PGSR records

  • 7. Has the host employer identified the most common causes of injury within their workplace?

  • Please name the common causes of injury

  • Does the host employer have a Risk Register for the tasks that are being undertaken?

  • Please provide a copy for PGSR records

  • 8. Does the host employer have a procedure for procurement in which safety is included?

  • Please provide a copy for PGSR records

  • 9. Does the host employer have written safe work procedures that reflect the way in which jobs should be done to ensure safety, or are they simply question/answer style work instructions?

  • Please provide a copy for PGSR records

  • 10. Does the host employer know which health and safety legislation applies to their business?

  • What can we do about this?

Implementation: Health & Safety Issue

  • 1. Does the host employer make people in their workplace aware of their health and safety responsibilities?

  • Conducts Pre Project Induction

  • Provides Company Policy/Procedure

  • Provides clear documented instructions on employees health and safety responsibilities

  • 2. Does the host employer provide workers with information, training and supervision to ensure they perform the work safely?

  • Training is provided

  • Supervision is provided

  • Safe Work Procedures are provided

  • Other

  • 3. Does the host employer have a specific documented process in place for managing the safety of workers and contractors?

  • Please provide a copy for PGSR records

  • 4. Does the host employer have a formal induction process?

  • Please provide a copy for PGSR records

  • 5. Does the host employer keep WHS and other training records?

  • Please provide a copy for PGSR records

  • 6. Does the host employer ensure incidents are reported, investigated and actions taken to prevent a recurrence, and are followed up? If so, How?

  • Please provide a copy for PGSR records

  • If so, How?

  • 7. Does the host employer provide workers with suitable personal protective equipment?

  • Hard Hat

  • Safety Foot Wear

  • Hi Vis Protective Shirts

  • Hi Vis Protective Pants

  • Other?

  • 8. Have the host employer's workers been trained to correctly use, maintain and store personal protective equipment?

  • What can we do about this?

  • 9. Is there a process to involve workers in workplace health and safety issues (e.g. consultations, toolbox meetings with two-way flow of information/WHS committee meetings)?

  • What can we do about this?

  • 10. Does the host employer have a formal (documented and well-understood) process for workers reporting safety concerns?

  • Please provide a copy for PGSR records

  • 11. Does the host employer ensure workers adhere to the policies and procedures? If so, how?

  • What can we do about this?

  • If so, how?

  • 12. Is there a documented process for identifying the hazards that can cause injury, harm or illness and for ensuring the risks are controlled?

  • Please provide a copy for PGSR records

  • 13. Are hazardous substance clearly labelled and safely stored?

  • What can we do about this?

  • 14. Is there a folder or software system that contains material safety data sheets for all substances used or stored at the workplace?

  • What can we do about this?

  • 15. Are residual current devices (safety switches) fitted to electrical equipment that is frequently moved?

  • What can we do about this?

  • 16. Are all circuits protected with earth leakage circuit breakers?

  • What can we do about this?

  • 17. Does the host employer have emergency procedures for the workplace that reflect the types of emergencies they could encounter?

  • What can we do about this?

  • 18. Have the host employer's workers been trained in what to do in an emergency?

  • Pre Project Induction

  • Emergency Drills Conducted

  • 19. Are periodic checks made to ensure emergency exits are well signposted, easily opened and clear of obstacles?

  • What can we do about this?

  • 20. Do workers have access to adequate first aid facilities, such as first aid kits and wash stations?

  • What can we do about this?

Management and Evaluation: Health & Safety Issue

  • 1. Does the employer review the policies and procedures to identify whether they are working and still suitable?

  • What can we do about this?

  • 2. Is there a process to evaluate the recorded workplace injuries and illnesses?

  • What can we do about this?

  • 3. Does the host employer have a process in place to monitor their compliance with legal duties?

  • What can we do about this?

  • 4. Does the host employer have a process to periodically monitor health and safety in the workplace (i.e. to make sure the safety standard doesn't deteriorate)?

  • What can we do about this?

  • 5. Does the host employer have a process to report work-related injuries of illnesses to the labour hire agency?

  • What can we do about this?

  • How is this to be done?

  • Is the host employer aware incidents and injuries are to be reported to PGSR with 12hrs of the occurrence?

  • Has the Host Employer Safety representative been informed by PGSR?

  • 6. Does the host employer have a process to report and record any notifiable incidents to Workplace Health and Safety Authority?

  • What can we do about this?

  • 7. Are managers and supervisors reviewed against their management of safety?

  • What can we do about this?

Management review: Health & Safety issue

  • 1. Does the host employer have a program of evaluating their approach to health and safety that identifies whether the approach is properly implemented and is effective in meeting their WHS objectives?

  • What can we do about this?

  • 2. Does the host employer have a process for using the audit information within their WHS planning for future years?

  • What can we do about this?

  • 3. Does senior management review the outcomes of audits?

  • What can we do about this?

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.