HS&E Field Inspection Checklist (Jumpers)

• 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

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

• 3.5. Construction Induction Card?

  Yes

  No

  N/A

• 3.5.1. Construction Induction Card number?

• 3.5.2. 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. 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 Safety Equipment

• 5.1. Sharps kit available?

  Yes

  No

  N/A

• 5.2. Fire Blanket available?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Date

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

6.0 Documentation - CCT Must Have Access To:

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

7.0 Safe Work Practices Observed (Worksite Observation only)

• 7.1. Manual Handling Practices are appropriate?

  Yes

  No

  N/A

• 7.2. PPE Worn as Required?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

8.0 Essential Tools / Equipment - OPERATIONAL

• 8.1. Blue Exchange Tool

  Yes

  No

  N/A

• 8.2. Red Exchange Tool

  Yes

  No

  N/A

• 8.3. Side Cutters

  Yes

  No

  N/A

• 8.4. Pliers - Long Nose

  Yes

  No

  N/A

• 8.5. Portasol Soldering Iron fitted with 4.8mm tip

  Yes

  No

  N/A

• 8.6. ADSL Test Modem

  Yes

  No

  N/A

9.0 Environmental Controls

• 9.1. Environment Management Plan (EMP) available?

  Yes

  No

  N/A

• 9.2. Water and Waste Management Practices implemented?

  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