Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

JOB SPECIFICS

  • WORKS ORDER DETAILS

  • Claim Number

  • For Hub

  • Requested By

  • Purchase Order Number

  • Works Order Number

  • The person in control of the job is :

  • The person in control of the job is :

  • CLIENT DETAILS

  • Owners Name

  • Owners Contact Details

  • Tenants Name

  • Tenants Contact Details

  • Access Details (who to call, key given or left etc)

INITIAL INSPECTION

  • BUILDING TYPE

  • The Building Is

  • The Building is on

  • Is the home in a damp environment?

  • Floor Area M2

  • Internal Stud Height M

  • Comments:

  • HEALTH ISSUES

  • Is respiratory distress common?

  • Are occupants suffering from asthma that has worsened?

  • Are occupants suffering nose bleeds?

  • Are occupants suffering headaches?

  • Do occupants suffer from itchy eyes?

  • Do occupants suffer from rashes and/or skin lesions?

  • Do occupants notice an improvement when they leave the home for a period of time?

  • Comments

  • PSYCHOMETRIC CONDITIONS

  • Outdoor Temperature

  • Ambient Outdoor RH%

  • Indoor Temperature

  • Indoor RH%

  • Sub Floor Temperature

  • Sub Floor RH%

  • Equilibrium RH%

  • Moisture Content is (WME%)

  • CAUSE OF WATER INTRUSION

  • Rising Damp

  • Is there rising damp due to earthquake (explain)

  • Is rising damp from liquefaction under the floor?

  • Presence of liquefaction is

  • Consistency of Liquefaction is:

  • Is mould present?

  • Is sewage present?

  • Is pungent Odour present?

  • Is there water intrusion to the building envelope due to liquefaction?

  • Would you recommend removal of liquefaction?

  • Leaking Water/Drain Pipe

  • Is Water intrusion due to a leaking pipe?

  • Has leak been fixed?

  • Was leak caused by a sudden event?

  • Where is/was leak?

  • Photo

  • Weather Penetration

  • Is water intrusion due to leak in roof or building envelope?

  • Has leak been fixed?

  • Was leak caused by a sudden event?

  • Where is/was leak?

  • Photo

  • MOULD INSIDE

  • What type of mould exists inside?

  • Where is the mould located?

  • Photo

  • Does mould need to be physically removed?

  • MOULD IN SUB FLOOR

  • What type of mould exists under floor?

  • Where is the mould located?

  • Photo

  • Does mould need to be physically removed?

  • REMEDIATION STRATEGY RECOMENDATIONS

  • ECC/AIR IMPACT Testing of recommended?

  • Samples Taken?

  • Sample taken by:

  • Pre works 'make safe' subfloor decontamination recommended?<br> (Basic treatment to ensure the health and safety of tradesmen working in the area)

  • Pre works 'make safe' internal decontamination recommended?<br> (Basic treatment to ensure the health and safety of tradesmen working in the area)

  • Removal of Liquefaction Recomended?<br> (observations, access etc)

  • Mechanical drying of underfloor most likely required?<br> (estimated timeframe if known)

  • Placement and/or replacement of DPM in subfloor?

  • Physical removal of mould most likely required?

  • Mechanical drying inside home most likely required?<br> (estimated timeframe if known)

  • Post works FULL subfloor decontamination recommended?<br> (include notes re drying required etc)

  • Post works FULL internal decontamination recommended?<br> (include notes re drying required etc)

  • CONCLUSION

  • Recommended PPE Requirements prior to/or without 'make safe' decontamination treatment

  • Recommended PPE Requirements prior to/or without Full decontamination treatment

  • Recommended PPE Requirements post 'make safe' decontamination treatment

  • Recommended PPE requirement post FULL decontamination treatment

  • Comments

  • Quote for Recommended Remediation Provided?

SITE SPECIFIC SAFETY PLAN

1. WORKPLACE CONTROL AND HEALTH AND SAFETY MANAGEMENT

  • The on-site safety representative (SR) for this project is

  • The person in control of the workplace is :

2. NOTIFIABLE WORKS

  • We have Notifiable Works associated with our subcontract

  • DoL will be advised of Notifiable Works upon acceptance of quote

3. HAZARD MANAGEMENT

  • We will maintain an onside Hazard Register of all existing and new hazards and appropriate controls

  • We will prepare a written Task Analysis covering all significant hazards associated with our works, in conjunction with employees, and give it to site management before any work involving that hazard commences onsite

  • Are there hazardous products/processes associated with our subcontract works?

  • Appropriate Safety Data Sheets have been supplied to the main contractor?

  • Appropriate Safety Data Sheets have been are available on site?

4. COMMUNICATION/EMPLOYEE PARTICIPATION

  • The methods we use to communicate safety information to our employees are:

  • Daily Toolbox Talks - including covering site hazards and emergency/evacuation procedures

  • Monthly Health and Safety Meetings - covering use of equipment, hazards encountered

  • Pre-task Planning Meetings - Done first Visit to site post quote approval

  • Co-ordination Meetings

  • Other

  • Urgent Safety Updates are e-mailed and/or TXT to all staff and put on the router for the next Health and Safety Meeting

5. EMERGENCIES

  • Emergency Kit One (First Aid Kit, Confined space emergency kit, Fire Extinguisher) is located

  • Emergency Kit Two (First Aid Kit, Confined space emergency kit, Fire Extinguisher) is located

  • We have trained First Aid personnel and procedures in place on site to render assistance in the event of an accident/emergency

  • Our Designated Warden/First Aid person is

  • In the event of a site emergency or evacuation our personnel will report to our safety representative and assemble at the evacuation area shown on the Emergency Evacuation Plan

  • We have an Emergency Plan for all hazardous products and processes referred to in section 3 above

  • EMERGENCY PLAN AND PROCEDURES FOR HAZARDOUS WORK

  • Emergency Procedure: Evacuate to meeting point specified below, Role call, Dial 111 Emergency Services and/or administer First Aid if required

  • Evacuation Plan for all Emergency Situations: Alarm Evacuation, Unsound Building, Earthquake, Fire, Tsunami, Other

  • Evacuation Plan 3: Other

6. ACCIDENT/INCIDENT: REPORTING/INVESTIGATION/RECORDING

  • We have an accident/incident reporting/investigation system in place and keep an Accident/Incident Register

  • We will immediately notify all serious harm accidents to site management and follow up within 7 days with a completed copy of the Accident and Incident Investigation Report

7. SAFETY INSPECTIONS AND SAFETY REVIEWS

  • We agree to undertake safety inspections and reviews at the intervals required by the Safety Activity Monitoring Register Wall Chart

  • A sample of documentation of our safety inspections has been sent to the main contractor

8. TRAINING/INDUCTION

  • All persons under our control hold current passports or induction pass cards as required

  • All persons under our control on site are given a site specific safety induction

  • All persons under our control on site are appropriately qualified, competent or fully supervised

9. SUBCONTRACTORS

  • Will we have subcontractors working for you on this project

  • Subcontractors to provide SSSP

  • Subcontractors to provide Task Analysis

SIGNATURE

  • Signature of Technician Compiling SSSP

  • Time and date Task Analysis Complete

TASK ANALYSIS

  • GENERAL STEPS

  • Step 1: Assess property for external hazards

  • Step 2: Familiarise customer with process and requirements

  • Step 3: Erect signs and barricades and/or check existing signs and barricades

  • Potential Hazard:

  • Control Methods:

  • Step 4: Don PPE according to task requirements as below

  • ---------------------------------------------------------------------------------------------------------------------------------------------------------

  • Step 5: As per task below

  • ---------------------------------------------------------------------------------------------------------------------------------------------------------

  • Step 6: Remove PPE

  • Potential Hazard:

  • Control Methods

  • Step 7: Ensure any signage being left onside is secure and visible

  • Step 8: Remove signage not being left onsite

  • Step 9: Check site and leave

  • ECC AND/OR AIR SAMPLING

  • A) Follow steps 1-4 of general

  • B) Load in equipment

  • Potential Hazard:

  • Control Methods:

  • C) Record observations including clients comments

  • D) Take samples as required

  • Potential Hazard:

  • Control Methods:

  • E) Follow steps 6-9 of general

  • DECONTAMINATION OF CRAWL SPACE

  • A) Follow steps 1-4 of general

  • B) Ensure all occupants and pets are out of the area to be decontaminated

  • Potential Hazard:

  • Control Methods:

  • C) Block all foundation vents

  • D) Load in equipment

  • Potential Hazard:

  • Control Methods:

  • E) Load in disinfectants and ensure they are safely stored and mixed

  • Potential Hazard

  • Control Methods

  • F) Treat Subfloor

  • Potential Hazard:

  • Control Methods:

  • G) Follow steps 6-9 of general

  • DECONTAMINATION OF INTERNAL ENVELOPE OF PROPERTY

  • A) Follow steps 1-4 of general

  • B) Load in equipment

  • Potential Hazard:

  • Control Methods:

  • C) Load in disinfectants and ensure they are safely stored and mixed

  • Potential Hazard

  • Control Methods

  • D) Take pre-air samples

  • Potential Hazard:

  • Control Methods:

  • E) Ensure all occupants and pets are out of the area to be decontaminated

  • Potential Hazard:

  • Control Methods:

  • F) Apply surface treatments

  • G) Set VHP and close up home

  • H) Follow steps 6-9 of general

  • POST TREATMENT SAMPLING

  • A) Follow steps 1-4 of general

  • B) Upon Re-entry, test VHP levels. Only re-enter if safe to do so

  • Potential Hazard:

  • Control Methods:

  • C) Take Post Samples

  • Potential Hazard:

  • Control Methods:

  • Signature of Technician Compiling Task Analysis

  • Time and date Task Analysis Complete

CHECKLIST

  • Initial inspection report complete?

  • SSSP Complete?

  • Task analysis complete?

  • Quote complete

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