I.C Pipes Safety Audit

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

CONTROL MEASURE

• A1 - Has a daily risk and hazard assessment (Hidra) been completed prior to starting work?

  Yes

  No

  N/A

• A2 - Have all employees or visitors signed the Hidra?

  Yes

  No

  N/A

• A3 - Has the Hidra been completed correctly and fully?

  Yes

  No

  N/A

• A4 - Have any overhead hazards been identified?

  Yes

  No

  N/A

• A5 - Have any specific traffic hazards been identified?

  Yes

  No

  N/A

• A6 - Have any other location hazards been identified (eg. School, steep incline etc.)?

  Yes

  No

  N/A

• A7 - Are bush fire safety measures in place?

  Yes

  No

  N/A

• A8 - Have any specific environmental issues relating to the site been identified?

  Yes

  No

  N/A

• A9 - Is there a controlled and approved copy of the current Safety Management Plan on site?

  Yes

  No

  N/A

• A10 - Is there a controlled and current copy of the Safe Work Method Statements on site?

  Yes

  No

  N/A

• A11 - Have there been any issues raised on this site that have not been identified in the Safe Work Method Statements?

  Yes

  No

  N/A

• A12 - Are all personnel inducted to this contract?

  Yes

  No

  N/A

• A13 - Are personnel carrying identification tags which are in reasonable condition?

  Yes

  No

  N/A

BASIC SAFETY ITEMS

• B1 - Are first aid kits readily available and fully stocked?

  Yes

  No

  N/A

• B2 - Is there a suitable fire extinguisher on site for potential fire risks?

  Yes

  No

  N/A

• B3 - Is the fire extinguisher within the service tag date?

  Yes

  No

  N/A

• B4 - Is the fire extinguisher safety pin secure and the lanyard/seal unbroken?

  Yes

  No

  N/A

• B5 - Is the fire extinguisher stored safely and easily accessible from the work site?

  Yes

  No

  N/A

• B6 - Is there adequate natural/artificial lighting on site?

  Yes

  No

  N/A

• B7 - Are there any hoses or cables running across the road?

  Yes

  No

  N/A

• B8 - If yes, is there someone in charge of monitoring their presence in the path of vehicles and people?

  Yes

  No

  N/A

• B9 - Are there any fuel containers on site?

  Yes

  No

  N/A

• B10 - Are the fuel containers correctly stored (150% of volume)?

  Yes

  No

  N/A

CLOTHING & PPE

• C1 - Are regulation helmets worn correctly at all times (within three years of manufacturers date)?

  Yes

  No

  N/A

• C2 - Are appropriate safety glasses or face-shields being worn where necessary?

  Yes

  No

  N/A

• C3 - Are appropriate respirators or filters being used when necessary?

  Yes

  No

  N/A

• C4 - Are gloves being worn where required?

  Yes

  No

  N/A

• C5 - Is safety footwear being worn by all operators?

  Yes

  No

  N/A

• C6 - Is ear protection being worn where necessary (20db disposable plugs, 80db ear muffs)?

  Yes

  No

  N/A

• C7 - Are all operators wearing high visibility clothing in good condition?

  Yes

  No

  N/A

CONFINED SPACES & ASSOCIATED HAZARDS

• D1 - Has a gas monitor been response tested and recorded on the appropriate documentation?

  Yes

  No

  N/A

• D2 - What is the serial number of the gas monitor on site?

  Yes

  No

  N/A

• D3 - Is the gas monitor within calibration date?

  Yes

  No

  N/A

• D4 - Has the testing of the manhole been recorded on the entry permit or Hidra sheet?

  Yes

  No

  N/A

• D5 - Are all operators entering confined space currently trained?

  Yes

  No

  N/A

• D6 - Is the standby person confined space trained?

  Yes

  No

  N/A

• D7 - Name of nominated person for confined space entry:

• D8 - Name of nominated person for standby duties:

• D9 - Are correct confined space procedures being followed?

  Yes

  No

  N/A

• D10 - Has the confined space entry permit been filled out?

  Yes

  No

  N/A

• D11 - Has the entry permit been filled out correctly and signed?

  Yes

  No

  N/A

• D12 - Is there an approved tripod on site?

  Yes

  No

  N/A

• D13 - Is the tripod fully extended?

  Yes

  No

  N/A

• D14 - What is the tripods serial/ID number?

• D15 - Is there a full parachute type harness on site?

  Yes

  No

  N/A

• D16 - Is the harness in good condition and within life expectancy?

  Yes

  No

  N/A

• D17 - What is the serial number of the harness?

• D18 - Is there an air rescuer on site and within its 10yr life expectancy?

  Yes

  No

  N/A

• D19 - Is there a grate covering any unattended manholes?

  Yes

  No

  N/A

• D20 - Is there "Confined Space entry by permit only" signage displayed on site?

  Yes

  No

  N/A

CCTV & JETTING

• E1 - Have the Safe Work Method Statements been identified for this process?

  Yes

  No

  N/A

• (a) work instruction WI 034 high pressure water jetting mainlines

  Yes

  No

  N/A

• (b) safe work method statement WMS 003 clean & CCTV sewer conduit

  Yes

  No

  N/A

• E2 - Is the jetter hose in good condition?

  Yes

  No

  N/A

• E3 - Is access to and from the vehicle safe and acceptable?

  Yes

  No

  N/A

• E4 - Is there a 110mm gap to prevent back-flow from the jetted reservoir?

  Yes

  No

  N/A

• E5 - Is there a back flow prevention device on the stand pipe?

  Yes

  No

  N/A

• E6 - Is there a current certificate for the back-flow prevention device?

  Yes

  No

  N/A

TRAFFIC CONTROL

• F1 - Is there an approved traffic control plan in place?

  Yes

  No

  N/A

• F2 - What is the traffic control plan number?

• F3 - Are advisory signs as per the traffic control plan selected?

  Yes

  No

  N/A

• F4 - Is there the requirement for traffic controllers on site?

  Yes

  No

  N/A

• F5 - What is/are the name(s) of the traffic controller or company?

• F6 - Does the traffic controller hold the required certificate (blue card)?

  Yes

  No

  N/A

• F7 - Is there a requirement for a certified traffic control agency?

  Yes

  No

  N/A

• F8 - Does the traffic control agency hold an approved management plan (by the RTA or council) on site?

  Yes

  No

  N/A

• F9 - Has a representative of I.C Pipes or associated contractors sighted the traffic control plan?

  Yes

  No

  N/A

• F10 - Are sufficient advisory signs being used and correctly placed?

  Yes

  No

  N/A

• F11 - Is the access around the worksite safe for the public?

  Yes

  No

  N/A

TRAFFIC CONTROL Continued....

• F12 - Is there a current Council Permit or written authorisation on site?

  Yes

  No

  N/A

• F13 - Is there a current approved Police Permit on site?

  Yes

  No

  N/A

• F14 - Are all traffic controllers correctly dressed and correctly situated?

  Yes

  No

  N/A

• F15 - Is there a qualified relief person on site?

  Yes

  No

  N/A

• F16 - Is signage in good condition?

  Yes

  No

  N/A

• F17 - Do traffic controllers have escape routes?

  Yes

  No

  N/A

• F18 - Are there night wands on site if at night?

  Yes

  No

  N/A

• F19 - Are pedestrians and cyclists catered for at site?

  Yes

  No

  N/A

• F20 - Are pedestrian managers required on site?

  Yes

  No

  N/A

SIGNAGE

• G1 - Are there 2 x "pedestrians watch your step" signs on site or stored?

  Yes

  No

  N/A

• G2 - Are there 2 x "part road closure" signs on site or stored?

  Yes

  No

  N/A

• G3 - Are there 4 x "dig man ahead" signs on site or stored?

  Yes

  No

  N/A

• G4 - Are there 2 x "chevron left/right" signs on site or stored?

  Yes

  No

  N/A

• G5 - Condition of signage:

  Good

  average

  poor

PLANT

• H1 - Operators and/or Drivers name(s):

• H2 - Are the plant/vehicle operators licensed to do so?

  Yes

  No

  N/A

• H3 - What class of drivers license does driver hold?

• H4 - When does the vehicles Rego expire?

  Date

• H5 - What is the vehicles Registration number?

H6 - Visual inspection of:

• (a) Tyres

  Pass

  Fail

• (b) Lights

  Pass

  Fail

• (c) Horn

  Pass

  Fail

• (d) Windscreen & windows

  Pass

  Fail

• (e) Bodywork

  Pass

  Fail

• (f) Hydraulics

  Pass

  Fail

• (g) Towing mechanism

  Pass

  Fail

PLANT Continued...

• H7 - Is the cabin neat and tidy?

  Yes

  No

  N/A

• H8 - Is there a spare tyre and jack for this vehicle?

  Yes

  No

  N/A

• H9 - Is there safe access onto or into the vehicle (steps etc.)?

  Yes

  No

  N/A

• H10 - Is the work area of the vehicle tidy and is all equipment used or stored correctly?

  Yes

  No

  N/A

H11 - Does this vehicle have a towed attachment?

• (a) Tyres

  Pass

  Fail

• (b) Lights

  Pass

  Fail

• (c) Towing mechanism

  Pass

  Fail

• H12 - What is the vehicles Registration number?

• H13 - When does the vehicles Rego expire?

  Date

ELECTRICAL

• I1 - Are all electrical leads and portable equipment tested and tagged?

  Yes

  No

  N/A

• I2 - Are all portable generators, extension leads and power tools protected with earth leakage devices?

  Yes

  No

  N/A

• I3 - Is an earth lead being used?

  Yes

  No

  N/A

• I4 - Is an electrical logbook on site?

  Yes

  No

  N/A

• I5 - Is the electrical logbook completed correctly?

  Yes

  No

  N/A

HOUSEKEEPING

• J1 - Is the general wok area tidy and are materials stored correctly?

  Yes

  No

  N/A

• J2 - Are noise requirement being adhered to?

  Yes

  No

  N/A

• J3 - Are bins being used?

  Yes

  No

  N/A

• J4 - On completion has the site been left as it was found?

  Yes

  No

  N/A

• J5 - Are start times (7am onwards) being adhered to?

  Yes

  No

  N/A

ADDITIONAL COMMENTS

• General:

• Actions needed:

Inspection carried out by:

• Sign:

  Sign

• Date:

  Date

Witness:

• Sign:

  Sign

• Date:

  Date