HS&E Field Inspection Checklist (BCIMs)

• Document No.

• Auditee's Name:

• Audit Location:

• Location
  Address

• CCT ID:

• Conducted on

  Date

• Auditor's Name:

• Vehicle Registration Number:

  Yes

  No

  N/A

1.0 Personal Protective Equipment (PPE)

• 1.1. Safety Boots (steel capped) X 2?

  Yes

  No

  N/A

• 1.2. Riggers Gloves?

  Yes

  No

  N/A

• 1.3. Safety Helmet / Hard Hat? (3 years from manufacture date)?

  Yes

  No

  N/A

• Expiry date?

  Date

• 1.4. Safety Helmet / Harness? (2 years from manufacture date)?

  Yes

  No

  N/A

• Expiry date?

  Date

• 1.5. Safety Glasses (AS stamped)?

  Yes

  No

  N/A

• 1.6. Hearing Protection - General purpose ear muffs?

  Yes

  No

  N/A

• 1.7. Safety rope?

  Yes

  No

  N/A

• 1.8. High Visibility Safety Vest?

  Yes

  No

  N/A

• 1.9. Full Body Harness? (within 10 years)

  Yes

  No

  N/A

• 1.9.1. Serial Number

• 1.9.2. Expiry date

  Date

• 1.10. Pole Strap? (To be used in conjunction with harness - within 10 years)

  Yes

  No

  N/A

• 1.10.1. Serial Number

• 1.10.2. Expiry date

  Date

• 1.11. Gas Detector - 4 sensors?

  Yes

  No

  N/A

• 1.11.1. Serial Number

• 1.11.2. Expiry date for calibration certificate

  Date

• 1.12. Pit Key - size appropriate?

  Yes

  No

  N/A

• 1.13. LV Rubber Gloves 650V (Electrical)

  Yes

  No

  N/A

• 1.13.1. Expiry Date (12 months from stamped date on glove)

  Date

2.0 First Aid

• 2.1. First Aid Kit (Approved Marking +) meets Model Code of Practice contents?

  Yes

  No

  N/A

• 2.2. Signage on Vehicle to indicate location of First Aid Kit?

  Yes

  No

  N/A

• 2.3. Contents within expiry date?

  Yes

  No

  N/A

• 2.3.1. Expiry Date of Eye wash

  Date

3.0 Licences and Accreditation

• 3.1. ISGM Issued Photo ID Card?

  Yes

  No

  N/A

• 3.1.1. Card number?

• 3.1.2. Expiry Date

  Date

• 3.2. Telstra Issued Photo ID Card?

  Yes

  No

  N/A

• 3.1.1. Card number?

• 3.1.2. Expiry Date

  Date

• 3.3. Drivers Licence? (current and relevant for applicable vehicle)

  Yes

  No

  N/A

• 3.3.1. Drivers Licence number?

• 3.3.2. Drivers Licence Expiry Date

  Date

• 3.4. Network Owners Letter of Identification?

  Yes

  No

  N/A

• 3.1.2. Date of Letter of Identification

  Date

• 3.4. Power Awareness Card?

  Yes

  No

  N/A

• 3.4.1. Power Awareness Card number?

• 3.4.2. Power Awareness Card Expiry Date

  Date

• 3.5. ACMA Licence?

  Yes

  No

  N/A

• 3.5.1. ACMA Licence number?

• 3.5.2. ACMA Licence Expiry Date

  Date

• 3.6. Construction Induction Card?

  Yes

  No

  N/A

• 3.6.1. Construction Induction Card number?

• 3.6.2. Construction Induction Card Issue Date

  Date

4.0 Vehicle Inspection

• 4.1. Make?

• 4.2. Model?

• 4.3. Registered?

  Yes

  No

  N/A

• 4.3.1. Registration Number?

• 4.3.2. Date Registration Expires

  Date

• 4.4. Colour of Vehicle

• 4.5. Lights - Check operation of brake, indicator and reversing lights. All operational?

  Yes

  No

  N/A

• 4.6. Vehicle jack, handle and brace?

  Yes

  No

  N/A

• 4.7. Cargo Barrier Installed?

  Yes

  No

  N/A

• 4.8. Vehicle in good condition - free of damage?

  Yes

  No

  N/A

• 4.9. Windscreen condition OK, no chips or cracks?

  Yes

  No

  N/A

• 4.10. Signage/branding visible?

  Yes

  No

  N/A

5.0 Environmental Controls

• 5.1. Environmental Management Plan (EMP) available?

  Yes

  No

  N/A

• 5.2. Water and Waste Management practices appropriate?

  Yes

  No

  N/A

• 5.3. Asbestos removal controls - double bags, P2 dust mask, disposable gloves and overalls?

  Yes

  No

  N/A

6.0 Safety Equipment

• 6.1. Sharps kit available?

  Yes

  No

  N/A

• 6.2. Rubber Mat electrical 650V rated?

  Yes

  No

  N/A

• 6.3. Manhole Guards x 1 full set?

  Yes

  No

  N/A

• 6.4. Witches Hats x 6 (450mm)?

  Yes

  No

  N/A

• 6.5. Road Safety Pedestrian Sign ('Watch Your Step' or 'Workman Ahead')?

  Yes

  No

  N/A

• 6.6. 240v Electrical Leads and tools (6 monthly test and tagged)?

  Yes

  No

  N/A

• 6.6.1. Date Next Test Due

  Date

• 6.7. RCD Tested if 240v tools or leads carried?

  Yes

  No

  N/A

• 6.7.1. Date Next RCD Test Due

  Date

• 6.8. Lock Out Tags available?

  Yes

  No

  N/A

• 6.9. Fire Blanket available?

  Yes

  No

  N/A

• 6.10. Fire Extinguisher available (and in date)?

  Yes

  No

  N/A

• 6.10.1. Next Test Date for Fire Extinguisher (tested every 6 months)

  Date

• 6.11. Equipotential Bonding Straps available (HFC work only)?

  Yes

  No

  N/A

• 6.12. Pole bag available?

  Yes

  No

  N/A

• 6.13. Esky - chemical approved (for Butane/Portasol)?

  Yes

  No

  N/A

• 6.14. Insulated Rods available?

  Yes

  No

  N/A

• 6.15. Insulated 'fishing' device available?

  Yes

  No

  N/A

• 6.16. Fibreglass Extension Ladder available and in good condition?

  Yes

  No

  N/A

• 6.17. Fibreglass Step Ladder available and in good condition?

  Yes

  No

  N/A

• 6.18. Gas Bottle LPG 1kg in good condition?

  Yes

  No

  N/A

• 6.18.1. Testing date for bottle (Bottles to be tested every 10 years)

  Date

• 6.19. Gas regulator, hand piece, burner, neck tube all in good condition?

  Yes

  No

  N/A

• 6.20. Hose for gas bottle longer than 10 metres?

  Yes

  No

  N/A

• 6.21. Gas Safe Installed? (ventilated to outside and no ignition sources to be kept in safe)

  Yes

  No

  N/A

• 6.22. Insulated Screwdriver available?

  Yes

  No

  N/A

• 6.23. Wooden/Fibreglass handled crowbar available?

  Yes

  No

  N/A

• 6.24. Long Handled ( Wooden/Fibreglass) Shovel available?

  Yes

  No

  N/A

• 6.25. Torch available?

  Yes

  No

  N/A

• 6.26. Seal breaker available?

  Yes

  No

  N/A

• 6.27. Ladders Secured effectively to vehicle?

  Yes

  No

  N/A

• 6.28. Instructions on ladder use affixed to Ladder?

  Yes

  No

  N/A

7.0 Documentation - CCT Must Have Access To:

• 7.1. Working Access to CCCM Safety Management Plan & Site Safety Rules CCCM-PMP-002

  Yes

  No

  N/A

• 7.2. Working Access to Relevant Safe Work Method Statements (SWMS)

  Yes

  No

  N/A

• 7.3. Copies of Relevant Daily JSEA form, if required

  Yes

  No

  N/A

• 7.4. Safety Data Sheets (SDS) for all chemicals carried

  Yes

  No

  N/A

8.0 Safe Work Practices Observed (Worksite Observation only)

• 8.1. Manual Handling Practices are appropriate?

  Yes

  No

  N/A

• 8.2. PPE Worn as Required?

  Yes

  No

  N/A

• 8.3. Have services been identified? (If digging pot holing is required)?

  Yes

  No

  N/A

9.0 Essential Tools / Equipment - OPERATIONAL

• 9.1. Strippers - RG 6 and RG 11

  Yes

  No

  N/A

• 9.2. Crimpers - RG 6 and RG 11

  Yes

  No

  N/A

• 9.3. Torque Wrench - RG 6 and RG 11

  Yes

  No

  N/A

• 9.4. Isolation Box Security Tool -Large and Small

  Yes

  No

  N/A

• 9.5. Security Shield Tool

  Yes

  No

  N/A

• 9.6. Butane Torch

  Yes

  No

  N/A

• 9.7. Side Cutters

  Yes

  No

  N/A

• 9.8. Pliers - Flat Nose

  Yes

  No

  N/A

• 9.9. Pliers - Long Nose

  Yes

  No

  N/A

• 9.10. Jointers Fire Blanket

  Yes

  No

  N/A

• 9.11. Cordless Drill

  Yes

  No

  N/A

• 9.12. Hacksaw

  Yes

  No

  N/A

BRIEF DESCRIPTION OF NON CONFORMANCE ISSUES

• NON CONFORMANCE ISSUE 1.0

• NON CONFORMANCE ISSUE 2.0

• NON CONFORMANCE ISSUE 3.0

• NON CONFORMANCE ISSUE 4.0

• NON CONFORMANCE ISSUE 5.0

• NON CONFORMANCE ISSUE 6.0

• NON CONFORMANCE ISSUE 7.0

• NON CONFORMANCE ISSUE 8.0

• NON CONFORMANCE ISSUE 9.0

• NON CONFORMANCE ISSUE 10.0

Sign Off

• CCT Signature

  Sign

• Reviewers Signature

  Sign

• Version Number 0.1 Dated 9 January 2013