Title Page

  • Workplace

  • Staff/Subcontractors

  • Date & Time

  • Inspected by

  • Location

PERSONNEL ON SITE

  • Are personnel wearing safety gear as required for the job they are doing?

  • Is the correct PPE being used as required by the task? (e.g. Safety vest, safety boots, safety glasses, hard hat, gloves, earplugs/muffs, long - long compliance, dust mask, respirator, face guards, guards evident on machines)

GENERAL SITE

  • Has the site been established correctly and are items safe and tidy?

  • Are hazards identified, recorded and =trolled on the Daily Job Start?

  • Have all staff and visitors signed the Daily Job Start?

  • Are work instructions on site for work being undertaken?

  • Are waratahs / reinforcing steel capped?

  • Is the work site dean and free of clutter?

  • Are tools and equipment safely stored? If excavating - have underground services been located?

  • Has the Ministry of Business Innovation and Employment been informed if work is notifiable?

ENVIRONMENTAL WORK PRACTICES

  • Are all environmental issues being addressed?

  • 1. If the work being undertaken under resource or building consent, is a copy of the consent onsite? And if required an up to date copy of the E&SC Plan on site? (PSMC If yes - tan TSL E&SC Inspection Form)

  • 2. If there is a dump site — Is the dumpsite clean, clear of debris and compliant with Env controls (If applicable?)

  • 3. Are fuels and chemicals properly stored on site?

  • 4. Is there any unplanned flora or fauna damage?

  • 5. Have dean water diversion bunds/channels been installed to separate run-offtstormwater from earthworks and tracking activities?

  • 6. Have the erosion control measures been installed in accordance with local Regional Council guidelines (e.g. contour drains, no-rap, geotextile, mulch)?

  • 7. Have the sediment control measures been installed in accordance with local Regional Council guidelines (e.g. silt fences, decanting earth bunds)?

  • 8. Are vehicle wheels and tracks carrying material off site?

  • 9. If lime, concrete, asphalt or emulsion is being used, have curb & channel, water-tables and cesspits been bunded or sealed.

  • 10, Is waste material being disposed of or stored correctly? (29 Rubbish)

PLANT/EQUIPMENT

  • Is the following current and certified?

  • Are all WOF / COF / Rego / RUC / TUC current?

  • Do all drivers / operators have licences and endorsements?

  • Is all tie down equipment in good condition?

  • Are all drivers / operators wearing seat belts?

PUBLIC SAFETY

  • Are the following being use where appropriate?

  • Safety Mesh or Tape?

  • Solid Barriers?

  • Walkways or Temporary Footpaths?

TRAFFIC CONTROL

  • Are the following being use where appropriate?

  • Is a TMP required and on site?

  • If so, is the TMP approved and current?

  • Has the site been set out in accordance with the TMP?

  • Is there an accredited STMS responsible for the site?

  • Is the STMS available within the required timeframes?

  • Has a traffic control checklist/audit been completed?

  • Is there an escape route for the Traffic Controller?

EMERGENCY EQUIPMENT

  • Are the following items of safety equipment available and checked?

  • First Aid kits? Contents within expiry dates?

  • Fire Extinguishers? Fire Extinguisher within test date?

  • Is the site able to call for emergency assistance? (e.g. Fire, Police, Ambulance)

  • Spill Kits? Check content.

ELECTRICAL EQUIPMENT

  • Is all electrical equipment tested.tagged and protection used where required?

  • Tools? (e.g. Drills and grinders)

  • Extension Leads?

  • RCD Protection?

GENERAL

  • Are the following people safe/ visible and using the appropriate safety gear?

  • Visitors

  • Client/s Representative

SIGN OFF

  • Any Other Comments

  • Subcontractor's Signature

  • Supervisor's Signature

  • Contract Manager's Signature

  • Auditor's Signature

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.