Infrastruct Contracting On Site Risk Assessment v2

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Job Number

  Yes

  No

  N/A

• Crew Leader

  Yes

  No

  N/A

• Start On Site

  Date

• Finish on Site

  Date

• SWMS Applicable

  Select EWP Tree Cutting Tree Climbing Tree Cutting from the Ground Tree Felling Regrowth Herbicide Chipper Stump Grinding Fire Fighting slashing/Flail Mowing Brushcutting

  • EWP Tree Cutting
  • Tree Climbing
  • Tree Cutting from the Ground
  • Tree Felling
  • Regrowth Herbicide
  • Chipper
  • Stump Grinding
  • Fire Fighting
  • slashing/Flail Mowing
  • Brushcutting

• SWMS Applicable

  Select EWP Tree Cutting Tree Climbing Tree Cutting from the Ground Tree Felling Regrowth Herbicide Chipper Stump Grinding Fire Fighting slashing/Flail Mowing Brushcutting

  • EWP Tree Cutting
  • Tree Climbing
  • Tree Cutting from the Ground
  • Tree Felling
  • Regrowth Herbicide
  • Chipper
  • Stump Grinding
  • Fire Fighting
  • slashing/Flail Mowing
  • Brushcutting

• SWMS Applicable

  Select EWP Tree Cutting Tree Climbing Tree Cutting from the Ground Tree Felling Regrowth Herbicide Chipper Stump Grinding Fire Fighting slashing/Flail Mowing Brushcutting

  • EWP Tree Cutting
  • Tree Climbing
  • Tree Cutting from the Ground
  • Tree Felling
  • Regrowth Herbicide
  • Chipper
  • Stump Grinding
  • Fire Fighting
  • slashing/Flail Mowing
  • Brushcutting

• SWMS Applicable

  Select EWP Tree Cutting Tree Climbing Tree Cutting from the Ground Tree Felling Regrowth Herbicide Chipper Stump Grinding Fire Fighting slashing/Flail Mowing Brushcutting

  • EWP Tree Cutting
  • Tree Climbing
  • Tree Cutting from the Ground
  • Tree Felling
  • Regrowth Herbicide
  • Chipper
  • Stump Grinding
  • Fire Fighting
  • slashing/Flail Mowing
  • Brushcutting

• SWMS Applicable

  Select EWP Tree Cutting Tree Climbing Tree Cutting from the Ground Tree Felling Regrowth Herbicide Chipper Stump Grinding Fire Fighting slashing/Flail Mowing Brushcutting

  • EWP Tree Cutting
  • Tree Climbing
  • Tree Cutting from the Ground
  • Tree Felling
  • Regrowth Herbicide
  • Chipper
  • Stump Grinding
  • Fire Fighting
  • slashing/Flail Mowing
  • Brushcutting

• SWMS Applicable

  Select EWP Tree Cutting Tree Climbing Tree Cutting from the Ground Tree Felling Regrowth Herbicide Chipper Stump Grinding Fire Fighting slashing/Flail Mowing Brushcutting

  • EWP Tree Cutting
  • Tree Climbing
  • Tree Cutting from the Ground
  • Tree Felling
  • Regrowth Herbicide
  • Chipper
  • Stump Grinding
  • Fire Fighting
  • slashing/Flail Mowing
  • Brushcutting

• SWMS Applicable

  Select EWP Tree Cutting Tree Climbing Tree Cutting from the Ground Tree Felling Regrowth Herbicide Chipper Stump Grinding Fire Fighting slashing/Flail Mowing Brushcutting

  • EWP Tree Cutting
  • Tree Climbing
  • Tree Cutting from the Ground
  • Tree Felling
  • Regrowth Herbicide
  • Chipper
  • Stump Grinding
  • Fire Fighting
  • slashing/Flail Mowing
  • Brushcutting

• SWMS Applicable

  Select EWP Tree Cutting Tree Climbing Tree Cutting from the Ground Tree Felling Regrowth Herbicide Chipper Stump Grinding Fire Fighting slashing/Flail Mowing Brushcutting

  • EWP Tree Cutting
  • Tree Climbing
  • Tree Cutting from the Ground
  • Tree Felling
  • Regrowth Herbicide
  • Chipper
  • Stump Grinding
  • Fire Fighting
  • slashing/Flail Mowing
  • Brushcutting

• SWMS Applicable

  Select EWP Tree Cutting Tree Climbing Tree Cutting from the Ground Tree Felling Regrowth Herbicide Chipper Stump Grinding Fire Fighting slashing/Flail Mowing Brushcutting

  • EWP Tree Cutting
  • Tree Climbing
  • Tree Cutting from the Ground
  • Tree Felling
  • Regrowth Herbicide
  • Chipper
  • Stump Grinding
  • Fire Fighting
  • slashing/Flail Mowing
  • Brushcutting

• Vicinity Authority number From Issuing Officer

  Yes

  No

  N/A

• Nearest Medical Facility

  Yes

  No

  N/A

• Job Description

  Yes

  No

  N/A

All Personnel PPE Checked

• Helmet

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Steel Cap Boots

  Yes

  No

  N/A

• Protective Eyewear

  Yes

  No

  N/A

• Hi Vis Clothing (Cotton)

  Yes

  No

  N/A

• Chainsaw Chaps or Trousers

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

Other Checks

• Traffic Management Template Used

  Yes

  No

  N/A

• Aerial Rescue climbing gear checked & positioned in an easy access area on-site/emergency plan discussed with crew

  Yes

  No

  N/A

• Names of two site members who hold a current first aid certificate

  Yes

  No

  N/A

• Names of two site members who are trained in Aeriel Rescue

  Yes

  No

  N/A

• Emergency Procedures & information are readily available

  Yes

  No

  N/A

• Tree Integrity checked and discussed

  Yes

  No

  N/A

Environmental issues

• What is the ESA information

  Yes

  No

  N/A

• Has DEC been advised about entry permits

  Yes

  No

  N/A

Hazard Identification

What are the Potential Hazards

Vehicular Traffic

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Residual Risk? Use the Risk Matrix to re evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Pedestrian Traffic

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Biological Hazards ( I.e pests,allergenic trees etc)

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Environmental Conditions ( I.e adverse weather conditions, slippery surface etc)

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Plant

• Plant

  Chipper

  Chainsaw

  EWP

  Tractor

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Exposure to Noise

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Manual Handling

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Dangerous Goods ( fuel etc)

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Overhead Services( I.e powerlines)

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Underground Services

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Property Damage Existing ( take photo)

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Property Damage Possible (take photo)

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Other Potential Hazards

Hazard 1

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Hazard 2

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Hazard 3

• Hazard Present

  Yes

  No

  N/A

• What can go wrong (these are the Hazards) Where and what is the hazard on this specific worksite.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• What can you do to Reduce Risks (These are the controls) list the control measures required to eliminate or minimize the risk/s.

  Yes

  No

  N/A

• What Is The Risk? Use the Risk Matrix to evaluate the risk.

  Select Negligible Very Low Low Medium High Urgent Critical

  • Negligible
  • Very Low
  • Low
  • Medium
  • High
  • Urgent
  • Critical

• Who is Responsible?

  Managing Director

  Site Supervisor

  Crew Members

Additional Information When When Working Near Powerlines

• Refer to Section 10 of Western Power Work Practice Manual.

• Identify what Voltage you are working with

  Select Up to 1000kv 11KV 22KV 33KV 66KV 132KV 220KV 330KV

  • Up to 1000kv
  • 11KV
  • 22KV
  • 33KV
  • 66KV
  • 132KV
  • 220KV
  • 330KV

• What plant Clearance is required for the identified voltage

  Yes

  No

  N/A

• What Is the Ground Approach Distance (GAD)

  Select Low Voltage = 1.5 meters High Voltage 1KV up to 33KV = 1.2 meters 66KV = 1.5 meters 132 KV = 1.5 meters 132KV = 1.8 meters Over 132KV = 3 meters

  • Low Voltage = 1.5 meters
  • High Voltage 1KV up to 33KV = 1.2 meters
  • 66KV = 1.5 meters
  • 132 KV = 1.5 meters
  • 132KV = 1.8 meters
  • Over 132KV = 3 meters

• Identify what Service Wires you are working around

  Yes

  No

  N/A

• Witnessed and Sighted by ALL CREW MEMBERS ON - SITE BEFORE COMMENCEMENT OF WORKS - I acknowledge that I have discussed and understand the above mentioned potential hazards and control measure pertaining to this particular work site, and I am satisfied that the job can proceed safely.

• Crew Member

  Sign

• Crew Member

  Sign

• Crew Member

  Sign

• Crew Member

  Sign

• Crew Member

  Sign

• Crew Member

  Sign

• Crew Member

  Sign

• Crew Member

  Sign

• Crew Member

  Sign

• Crew Member

  Sign