Title Page

  • Site conducted

  • Conducted on

  • location
  • Work order number

  • Scope of work

  • Apprentice on site

Job Planning and Safe Systems of Work

  • Prestart / JSA completed and signed by all work members?

  • Relevant signed SWMS available for the task?

  • SDS forms accessed on the portal?

  • Are work permits required for the task?

  • Are all workers Origin inducted?

  • Trade licenses and industry Induction card sighted?

  • Alcohol Breath Test Completed

  • iPad in good condition?

Site induction and Site Office

  • Is the site secure and restricted access at the gate?

  • Does the site have a Safety Officer?

  • Sign in book and site induction if required?

  • Is additional PPE required and provided for the Auditor?

  • Has the site requested copies of licenses and safety documentation?

Vehicle

  • Vehicle Registration

  • Vehicle clean and free from damage?

  • Vehicle in service?

  • Gas Bottles secure?

  • items secured on vehicle for transit?

  • Fire extinguishers sighted and in date?

Site Safety

  • Is the correct PPE being used for the task?

  • Is it possible the workers could fall from height?

  • Are any fall protection or prevention devices being used or installed to protect workers from Falling from height?

  • Has the worker taken steps to minimize the handling of awkward or heavy materials and equipment?

  • If working around exposed live sources of electricity, confirm 3 meter exclusion zone has been implemented?

  • Electrical equipment test and tagged?

  • Power boards fitted with RCD?

Work Area and Tools

  • Are all tools in good condition and have guards fitted where applicable?

  • Is the work area clean and tidy, trip hazards minimized?

  • Is the area well ventilated?

  • Is this a confined space?

  • Have all work activities stopped?

  • Is the worker working in a hot environment / plant room?

  • If required does the worker have an operational CO personal monitor on site?

  • Have attempts being made to improve conditions such as fans, regular rest breaks and ample supply of water?

  • Are insects, rodents or any other pests present on site?

  • Is the worker working in isolation?

  • Is there a system of site monitoring or regular contact with the office?

Emergency Preparedness

  • Can the worker demonstrate a process for responding to an emergency on site?

  • Can the worker demonstrate an understanding of the emergency response ( what there role is in the event of an emergency)?

  • is a first aid kit available?

Sign Off

  • Auditor

  • Gas Fitter/ Plumber

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.