Initial Inspection and Site Specific Safety Plan/Task Analysis 1.2

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• 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 :

  Select Nick Donald 0210456296 Clifton Huger 0221926283 Jason Pickering 0273378051 Tracy Ford 021387229 Harry Thompson 0221987007 Daniel Pinto 02102687090

  • Nick Donald 0210456296
  • Clifton Huger 0221926283
  • Jason Pickering 0273378051
  • Tracy Ford 021387229
  • Harry Thompson 0221987007
  • Daniel Pinto 02102687090

• 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

  Single Storey

  Two Storeys

  Three Storeys

• The Building is on

  Piles

  Slab

  Other

• Is the home in a damp environment?

  Yes

  No

  N/A

• Floor Area M2

• Internal Stud Height M

• Comments:

• HEALTH ISSUES

• Is respiratory distress common?

  Yes

  No

  N/A

• Are occupants suffering from asthma that has worsened?

  Yes

  No

  N/A

• Are occupants suffering nose bleeds?

  Yes

  No

  N/A

• Are occupants suffering headaches?

  Yes

  No

  N/A

• Do occupants suffer from itchy eyes?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• Is rising damp from liquefaction under the floor?

  Yes

  No

  N/A

• Presence of liquefaction is

  Minor

  Medium

  Severe

  N/A

• Consistency of Liquefaction is:

  Wet

  Very Wet

  Slushy

  Ponding

  N/A

• Is mould present?

  Yes

  No

  N/A

• Is sewage present?

  Yes

  No

  N/A

• Is pungent Odour present?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Would you recommend removal of liquefaction?

  Yes

  No

  N/A

• Leaking Water/Drain Pipe

• Is Water intrusion due to a leaking pipe?

  Yes

  No

  N/A

• Has leak been fixed?

  Yes

  No

  N/A

• Was leak caused by a sudden event?

  Yes

  No

  N/A

• Where is/was leak?

• Photo

  Media

• Weather Penetration

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

  Yes

  No

  N/A

• Has leak been fixed?

  Yes

  No

  N/A

• Was leak caused by a sudden event?

  Yes

  No

  N/A

• Where is/was leak?

• Photo

  Media

• MOULD INSIDE

• What type of mould exists inside?

• Where is the mould located?

• Photo

  Media

• Does mould need to be physically removed?

  Yes

  No

  N/A

• MOULD IN SUB FLOOR

• What type of mould exists under floor?

• Where is the mould located?

• Photo

  Media

• Does mould need to be physically removed?

  Yes

  No

  N/A

• REMEDIATION STRATEGY RECOMENDATIONS

• ECC/AIR IMPACT Testing of recommended?

  Yes

  No

  N/A

• Samples Taken?

  Yes

  No

  N/A

• Sample taken by:

  Sign

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Placement and/or replacement of DPM in subfloor?

  Yes

  No

  N/A

• Physical removal of mould most likely required?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• CONCLUSION

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

  Category 1 - BA Respirator, Full Face Mask, C/Alls, Gloves and site specific PPE

  Category 2 - Full Face Respirator & Mask, C/Alls, Gloves and site specific PPE

  Category 3 - Respirator, Gloves and site specific PPE

  Category 4 - Site specific PPE

  Category 5 - No PPE Required

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

  Category 1 - BA Respirator, Full Face Mask, C/Alls, Gloves and site specific PPE

  Category 2 - Full Face Respirator & Mask, C/Alls, Gloves and site specific PPE

  Category 3 - Respirator, Gloves and site specific PPE

  Category 4 - Site specific PPE

  Category 5 - No PPE Required

• Recommended PPE Requirements post 'make safe' decontamination treatment

  Category 1 - BA Respirator, Full Face Mask, C/Alls, Gloves and site specific PPE

  Category 2 - Full Face Respirator & Mask, C/Alls, Gloves and site specific PPE

  Category 3 - Respirator, Gloves and site specific PPE

  Category 4 - Site specific PPE

  Category 5 - No PPE Required

• Recommended PPE requirement post FULL decontamination treatment

  Category 1 - BA Respirator, Full Face Mask, C/Alls, Gloves and site specific PPE

  Category 2 - Full Face Respirator & Mask, C/Alls, Gloves and site specific PPE

  Category 3 - Respirator, Gloves and site specific PPE

  Category 4 - Site specific PPE

  Category 5 - No PPE Required

• Comments

• Quote for Recommended Remediation Provided?

  Yes

  No

  N/A

SITE SPECIFIC SAFETY PLAN

1. WORKPLACE CONTROL AND HEALTH AND SAFETY MANAGEMENT

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

  Select Nick Donald 0210456296 Clifton Huger 0221926283 Jason Pickering 0273378051 Tracy Ford 021387229 Harry Thompson 0221987007 Daniel Pinto 02102687090

  • Nick Donald 0210456296
  • Clifton Huger 0221926283
  • Jason Pickering 0273378051
  • Tracy Ford 021387229
  • Harry Thompson 0221987007
  • Daniel Pinto 02102687090

• The person in control of the workplace is :

2. NOTIFIABLE WORKS

• We have Notifiable Works associated with our subcontract

  Yes

  No

  N/A

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

  Yes

  No

  N/A

3. HAZARD MANAGEMENT

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

  Yes

  No

  N/A

• 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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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

  In the Trade Vehicle

  On the Job Site

  Inside the Premises

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

  In the Trade Vehicle

  On the Job Site

  Inside the Premises

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

  Yes

  No

  N/A

• Our Designated Warden/First Aid person is

  Select Nick Donald 0210456296 Clifton Huger 0221926283 Jason Pickering 0273378051 Tracy Ford 021387229 Harry Thompson 0221987007 Daniel Pinto 02102687090

  • Nick Donald 0210456296
  • Clifton Huger 0221926283
  • Jason Pickering 0273378051
  • Tracy Ford 021387229
  • Harry Thompson 0221987007
  • Daniel Pinto 02102687090

• 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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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

  EVAC Plan 1- Meet at Building Entry

  EVAC Plan 2 - Meet at Trade Vehicle

  EVAC Plan 3 - 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

  Yes

  No

  N/A

• 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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

8. TRAINING/INDUCTION

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

9. SUBCONTRACTORS

• Will we have subcontractors working for you on this project

  Yes

  No

  N/A

• Subcontractors to provide SSSP

  Yes

  No

  N/A

• Subcontractors to provide Task Analysis

  Yes

  No

  N/A

SIGNATURE

• Signature of Technician Compiling SSSP

  Sign

• Time and date Task Analysis Complete

  Date

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:

  While investigating and/or erecting signs technician may be caught out by the very harm they are trying to minimise.

• Control Methods:

  Minimise - Technician to read on site hazard board/sheet prior to investigating site

  Isolate - Technician not to put barricades close to hazard rather at a safe distance

  Eliminate - Technician not to go into the area unless required

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

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

• Step 5: As per task below

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

• Step 6: Remove PPE

• Potential Hazard:

  Some PPE can be contaminated

• Control Methods

  Isolate Contaminated PPE - Put into secure bag/sealed container to contain contamination. Dispose of appropriately

  Isolate Uncontaminated PPE - Dispose of as required. Store in protective packets and/containers. Do NOT mix in with new /clean gear.

• 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:

  Electrical Hazard

• Control Methods:

  Minimise - Ensure all items are used through RCDs and have current electrical tags

• C) Record observations including clients comments

• D) Take samples as required

• Potential Hazard:

  Samples may need to be taken in confined spaces and/or contaminated zone

• Control Methods:

  Minimise - Confined space - ensure required PPE is worn, there is more than one person onsite and emergency tools are close at hand

  Minimise - Contaminated Zone Only - ensure required PPE is worn, there is more than one person onsite

• 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:

  Pets/animals often claim shelter under houses and can be adversely affected by treatment

• Control Methods:

  Eliminate - Ask occupants to remove the animals from the property while treatment is in progress, board up access points so other animals cannot enter while treatment is in progress

  Isolate - Check area for animals, board up access points so they cannot enter while treatment is in progress

  Minimise - Check area for animals, board up access points if possible so they cannot enter while treatment is in progress

• C) Block all foundation vents

• D) Load in equipment

• Potential Hazard:

  Electrical Hazard

• Control Methods:

  Minimise - Ensure all items are used through RCDs and have current electrical tags

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

• Potential Hazard

  Product could spill and/or accidentally mix with other products onsite

• Control Methods

  Minimise - only remove from the van products that are required at the time, return products to the van as soon as you have finished using them, ensure they are put away from other products in the property

• F) Treat Subfloor

• Potential Hazard:

  Treatment is in a confined space and contaminated zone

• Control Methods:

  Minimise - Confined space - ensure required PPE is worn, there is more than one person onsite and emergency tools are close at hand

  Minimise - Contaminated Zone Only - ensure required PPE is worn, there is more than one person onsite

• 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:

  Electrical Hazard

• Control Methods:

  Minimise - Ensure all items are used through RCDs and have current electrical tags

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

• Potential Hazard

  Product could spill and/or accidentally mix with other products onsite

• Control Methods

  Minimise - only remove from the van products that are required at the time, return products to the van as soon as you have finished using them, ensure they are put away from other products in the property

• D) Take pre-air samples

• Potential Hazard:

  Samples may need to be taken in confined spaces and/or contaminated zone

• Control Methods:

  Minimise - Confined space - ensure required PPE is worn, there is more than one person onsite and emergency tools are close at hand

  Minimise - Contaminated Zone Only - ensure required PPE is worn, there is more than one person onsite

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

• Potential Hazard:

  Occupants and Pets can be adversely affected by treatment, sometimes not realising the danger they will ignore advice and signage and enter the premises

• Control Methods:

  Eliminate - Explain the hazards to the occupants and ask occupants to leave the premises and remove the animals from the property while treatment is in progress, lock all doors, tape key holes, erect signage and barricades, check area before treatment to ensure none have been missed

  Minimise - Explain the hazards to the occupants and ask them to leave the premises and remove the animals from inside the property and secure them else ware while treatment is in progress, lock all doors, tape key holes, erect signage and barricades, check area before treatment to ensure none have been missed

• 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:

  Technician forgets to checks levels prior to entering

• Control Methods:

  Minimise - ensure PPE is put on prior to entering premises in all cases

• C) Take Post Samples

• Potential Hazard:

  Samples may need to be taken in confined spaces and/or contaminated zone

• Control Methods:

  Minimise - Confined space - ensure required PPE is worn, there is more than one person onsite and emergency tools are close at hand

  Minimise - Contaminated Zone Only - ensure required PPE is worn, there is more than one person onsite

• Signature of Technician Compiling Task Analysis

  Sign

• Time and date Task Analysis Complete

  Date

CHECKLIST

• Initial inspection report complete?

  Yes

  No

  N/A

• SSSP Complete?

  Yes

  No

  N/A

• Task analysis complete?

  Yes

  No

  N/A

• Quote complete

  Yes

  No

  N/A