HYDROGRAPHIC SERVICES TS WORKSITE SAFETY / ACTIVITY FORM

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

ENSURE YOU HAVE SAFE SITE

If "SAFE" or "N/A "is not entered for each relevant item on the checklist, work must not proceed without further Hazard identification and Controls implemented

1. Do you have permission to access this site?

• Example: Access Permit, Confined Space Entry Permit

  Yes

  No

  N/A

2. Where required, has the land owner been notified?

• Example: Client/Private owner and/or Thiess Services requirements

  Yes

  No

  N/A

3. Cultural Heritage

• Have Cultural Heritage requirements been satisfied before carrying out site modification or excavation work?

  Yes

  No

  N/A

4. Is fire fighting equipment serviced & available before starting work on site?

• Example: Extinguisher in vehicle or on site?

  Yes

  No

  N/A

5. In case of an emergency are alternative exits available?

• Example: Principal access/egress routes clear alternate escape route established?

  Yes

  No

  N/A

6. Is suitable communication equipment carried to enable emergency communication throughout the work?

• Example: Signal for mobile phone – satellite phone

  Yes

  No

  N/A

7. Is the site/proposed work to be undertaken covered by generic Risk Assessment/SWMS/Traffic Management Plan?

• Example: RAR for Stream Gauging/ Environmental Monitoring/Sampling/Deploy Plan

  Yes

  No

  N/A

8. Has a Site Hazard inspection been conducted to determine if potential risks exist? Provide detail in the Comments section

• Example: Changes to bank, track, surrounding environment, insitu equipment, weather

  Yes

  No

  N/A

9. Where required, can third party safety controls be established?

• Example: Client/ Landowner informed, signage to protect public

  Yes

  No

  N/A

Is suitable and serviced plant/equipment available to safely conduct the work?

• Example: Condition – leaks – spark arrestors

  Yes

  No

  N/A

Is suitable PPE available for use during the task being performed?

• Example: Safety glasses, leather, boots, gloves, hearing protections

  Yes

  No

  N/A

ADDITIONAL RISKS IDENTIFIED

• Note additional Hazards identified and relevant Controls

  Yes

  No

  N/A

• Add a drawing to assist with the identification of a new Hazard, Repair or modification required

  Drawing

OTHER COMMENTS

• Note comments here

  Yes

  No

  N/A

• Employee signature

  Sign

NOTE* This is an IPAD version of form TSWT-036390-MTP-FO-101