Information
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Document No.
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Auditee's Name:
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Audit Location:
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Location
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CCT ID:
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Conducted on
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Auditor's Name:
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Vehicle Registration Number:
1.0 Personal Protective Equipment (PPE)
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1.1. Safety Boots (steel capped) X 2?
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1.2. Riggers Gloves?
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1.3. Safety Helmet / Hard Hat? (3 years from manufacture date)?
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Expiry date?
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1.4. Safety Helmet / Harness? (2 years from manufacture date)?
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Expiry date?
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1.5. Safety Glasses (AS stamped)?
2.0 First Aid
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2.1. First Aid Kit (Approved Marking +) meets Model Code of Practice contents?
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2.2. Signage on Vehicle to indicate location of First Aid Kit?
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2.3. Contents within expiry date?
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2.3.1. Expiry Date of Eye wash
3.0 Licences and Accreditation
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3.1. ISGM Issued Photo ID Card?
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3.1.1. Card number?
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3.1.2. Expiry Date
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3.2. Telstra Issued Photo ID Card?
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3.1.1. Card number?
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3.1.2. Expiry Date
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3.3. Drivers Licence? (current and relevant for applicable vehicle)
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3.3.1. Drivers Licence number?
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3.3.2. Drivers Licence Expiry Date
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3.4. Network Owners Letter of Identification?
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3.1.2. Date of Letter of Identification
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3.5. Construction Induction Card?
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3.5.1. Construction Induction Card number?
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3.5.2. Construction Induction Card Issue Date
4.0 Vehicle Inspection
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4.1. Make?
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4.2. Model?
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4.3. Registered?
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4.3.1. Registration Number?
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4.3.2. Registration Expires?
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4.4. Colour of Vehicle
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4.5. Lights - Check operation of brake, indicator and reversing lights. All operational?
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4.6. Vehicle jack, handle and brace?
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4.7. Cargo Barrier Installed?
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4.8. Vehicle in good condition - free of damage?
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4.9. Windscreen condition OK, no chips or cracks?
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4.10. Signage/branding visible?
5.0 Safety Equipment
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5.1. Sharps kit available?
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5.2. Fire Blanket available?
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5.3. Fire Extinguisher available (and in date)?
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5.3.1. Next Test Date for Fire Extinguisher (tested every 6 months)
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5.4. Gas Safe Installed? (ventilated to outside and no ignition sources to be kept in safe)
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5.5. Esky - chemical approved (for Butane / Portasol)?
6.0 Documentation - CCT Must Have Access To:
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6.1. Working Access to CCCM Safety Management Plan & Site Safety Rules CCCM-PMP-002
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6.2. Working Access to Relevant Safe Work Method Statements (SWMS)
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6.3. Copies of Relevant Daily JSEA form, if required
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6.4. Safety Data Sheets (SDS) for all chemicals carried
7.0 Safe Work Practices Observed (Worksite Observation only)
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7.1. Manual Handling Practices are appropriate?
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7.2. PPE Worn as Required?
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7.3. Have services been identified? (If digging pot holing is required)?
8.0 Essential Tools / Equipment - OPERATIONAL
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8.1. Blue Exchange Tool
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8.2. Red Exchange Tool
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8.3. Side Cutters
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8.4. Pliers - Long Nose
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8.5. Portasol Soldering Iron fitted with 4.8mm tip
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8.6. ADSL Test Modem
9.0 Environmental Controls
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9.1. Environment Management Plan (EMP) available?
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9.2. Water and Waste Management Practices implemented?
BRIEF DESCRIPTION OF NON CONFORMANCE ISSUES
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NON CONFORMANCE ISSUE 1.0
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NON CONFORMANCE ISSUE 2.0
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NON CONFORMANCE ISSUE 3.0
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NON CONFORMANCE ISSUE 4.0
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NON CONFORMANCE ISSUE 5.0
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NON CONFORMANCE ISSUE 6.0
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NON CONFORMANCE ISSUE 7.0
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NON CONFORMANCE ISSUE 8.0
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NON CONFORMANCE ISSUE 9.0
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NON CONFORMANCE ISSUE 10.0
Sign Off
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CCT Signature
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Reviewers Signature
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Version Number 0.1 Dated 9 January 2013
