Initial Inspection Report & SSSP Checklist

REPORT

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

The Occupants suffer from

Respiratory Distress
Asthma
Nose Bleeds
Headaches
Itchy Eyes
Rashes and/or Skin lesions
Other
No health issues
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%)

ISSUE

Description of the problem

Problems Identified

Mould Contamination
Possible Sewerage Contamination
Pungent Odour Present
Other Contaminants
Other
N/A

POSSIBLE CAUSE

POSSIBLE CAUSE OF THE PROBLEM

Liquefaction
Rising Damp
Water Intrusion
Leaking/Burst Pipe
Other
N/A

REMEDIATION STRATEGY RECOMENDATIONS

ECC/AIR IMPACT Testing of recommended?

Recommended PPE BEFORE or without decontamination treatment

Category 1 - BA Respirator, Full Face Mask, C/Alls, Gloves and site specific PPE
Category 2 - Full Face Mask, C/Alls, Gloves and site specific PPE
Category 3 - Half Face Mask, Gloves and site specific PPE
Category 4 - Site specific PPE
Category 5 - No PPE Required
N/A

Pre works 'make safe' decontamination recommended for.... (Basic treatment to ensure the health and safety of tradesmen working in the area)

Inside
Subfloor
Other
N/A

Mechanical drying most likely required for.... (estimated timeframe if known)

Inside
Subfloor
Other
N/A

Removal of Liquefaction Recomended?
(observations, access etc)

Placement and/or replacement of DPM in subfloor recommended?

Physical removal of mould most likely required? (Describe)

Post works FULL decontamination recommended for.... (Basic treatment to ensure the health and safety of the occupants)

Inside
Subfloor
Other
N/A

CONCLUSION

Comments

SSSP

ABOUT THE SSSP

- This SSSP is unique to each site being worked on. It is to be completed by the accreditation contractor prior to the commencement of work and submitted, along with the quote, for acceptance.
- The SSSP is a live document and must be updated during the work process to address changes to site hazards and workers on the site.
- The occupants of the property must be inducted into the SSSP. Occupants who are relocating off-site during the repair work must be advised of all precautions they must take if they return to their home at any time during the repair process.

1.0 SITE REQUIREMENTS

Site Specific Safety Plan

Site Evacuation Plan (copy attached)

Site Hazard Register (copy attached)

Site Induction Register to be used?

Site Hazard Board to be used?

Site Sign-In Sheet to be used?

First Aid Kit Located Onsite

Fire Extinguisher Located Onsite

Any Council Permits Required

Hazardous Substances used on site?

All hazardous substances listed on Haz. Register

2.0 HIGH RISK WORK

- If High Risk work is being undertaken then a Task Analysis must be submitted for each high risk job.
- All persons involved in High Risk must have received instruction and have read and understood the relevant Task Analysis, and be competent to complete the task they are assigned.

1. Friable asbestos work being carried out?

2. Non-Friable asbestos work being carried out?

3. Major Demolition work being carried out?

4. Use of elevating work platforms required?

5. Any working on roofs required?

6. Work in confined or restricted spaces required?

7. Work within 4.0m of overhead power lines?

8. Is there any other high risk work?

3.0 NOTIFIABLE WORK

Work defined by the MBIE Labour Group as 'Notifiable Work' (including 'Restricted Work') must be notified to the Labour Group by the Contractor using the appropriate documents.

Any Notifiable Work being carried out?

4.0 ACKNOWLEDGEMENT OF RESPONSIBILITIES

1. I confirm that all employees and sub-contractors to be working on site will have completed an induction course and will be in possession of a valid Identification Card.
2. I confirm all staff and sub-contractors working on site will be informed of the site rules (EQR Rules).
3. I confirm Tool Box Talks will be carried out and all Safety Alerts communicated to staff and sub-contractors.
4. I confirm that all persons on site will be competent to complete assigned tasks or will be fully supervised by someone who is.
5. I am aware of the hazards identified on this site and of my responsibilities to identify any additional hazards and take all practicable steps to eliminate, isolate or minimise those hazards.

Person Completing SSSP

Date

HIGH RISK WORK TASK ANALYSIS

High Risk Works being carried out (Not already covered in General Task Analysis)

Asbestos Work
Major Demolition Work
Use of elevation Platforms
Working on Roofs
Working in confined/restricted space
work within 4.0m of overhead powerlines
Other high risk work

Does MBIE Labour Group need to be notified?

Specialist Asbestos Task Analysis has been compiled

refer to General Task Analysis for details on common tasks

Does MBIE Labour Group need to be notified?

TASK ANALYSIS STEPS

Step

Description of Step

For this step I could

Strain or sprain my back or other muscle
Be caught in, on or between anything
Slip, trip or fall from height, on the same or lower level
Be injured by poor plant/job design
Be struck by or against anything
Come in contact with a hazardous substance
Come in contact with an energy source

refer to General Task Analysis for details on common tasks

Does MBIE Labour Group need to be notified?

TASK ANALYSIS STEPS

Step

Description of Step

For this step I could

Strain or sprain my back or other muscle
Be caught in, on or between anything
Slip, trip or fall from height, on the same or lower level
Be injured by poor plant/job design
Be struck by or against anything
Come in contact with a hazardous substance
Come in contact with an energy source

refer to General Task Analysis for details on common tasks

Does MBIE Labour Group need to be notified?

TASK ANALYSIS STEPS

Step

Description of Step

For this step I could

Strain or sprain my back or other muscle
Be caught in, on or between anything
Slip, trip or fall from height, on the same or lower level
Be injured by poor plant/job design
Be struck by or against anything
Come in contact with a hazardous substance
Come in contact with an energy source

refer to General Task Analysis for details on common tasks

Does MBIE Labour Group need to be notified?

TASK ANALYSIS STEPS

Step

Description of Step

For this step I could

Strain or sprain my back or other muscle
Be caught in, on or between anything
Slip, trip or fall from height, on the same or lower level
Be injured by poor plant/job design
Be struck by or against anything
Come in contact with a hazardous substance
Come in contact with an energy source

refer to General Task Analysis for details on common tasks

Does MBIE Labour Group need to be notified?

TASK ANALYSIS STEPS

Step

Description of Step

For this step I could

Strain or sprain my back or other muscle
Be caught in, on or between anything
Slip, trip or fall from height, on the same or lower level
Be injured by poor plant/job design
Be struck by or against anything
Come in contact with a hazardous substance
Come in contact with an energy source

refer to General Task Analysis for details on common tasks

Does MBIE Labour Group need to be notified?

OTHER HIGH RISK WORK

HIGH RISK WORK

Brief Description of High Risk Work

TASK ANALYSIS STEPS

Step

Description of Step

For this step I could

Strain or sprain my back or other muscle
Be caught in, on or between anything
Slip, trip or fall from height, on the same or lower level
Be injured by poor plant/job design
Be struck by or against anything
Come in contact with a hazardous substance
Come in contact with an energy source

refer to General Task Analysis for details on common tasks

GENERAL TASK ANALYSIS

DAILY

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

STEP 4: Don PPE according to task requirements as below

TASK SPECIFIC

STEP 5: Follow steps as required by job tasks

Tasks Associated with this job

ECC and/or Air Sampling
Sub Floor Decontamination Treatment
Full Internal Decontamination Treatment
Part Internal Decontamination Treatment
Physical Contamination Removal
Other

A) Use Equipment as required
Potential Hazards: Electrical Hazards
Control Methods: Minimise - Ensure all items are used through RCDs and have current electrical tags.

B) Record observations including any clients comments

C) Take samples as required
Potential Hazard: Samples may need to be taken in confined spaces and/or contaminated zones
Control Methods: Minimise - Ensure required PPE is worn, there is more than one person onsite and
emergency tools are close at hand. If in confined space refer to

D) Ensure correct signage being left onsite for this step is secure and visible

A) 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/area
while treatment is in progress. Check area to ensure none
remain, board up access points so other animals cannot enter
while treatment is in progress

B) Block all foundation vents

C) Load in equipment
Potential Hazard: Electrical Hazard
Control Methods: Isolate/Minimise - Ensure all items are used through RCDs and
have current electrical tags. Make sure cords
are not across walkways where possible.

D) Load in disinfectants and ensure they are safely stored and mixed
Potential Hazard: Spillages, accidental mixing (chemical cocktail)
Control Method: Minimise - Only remove from the van products that are
required at any one time. Ensure they are stored
and put away from any other products in the property

E) Treat Subfloor
Potential Hazard: Treatment is generally in a confined and contaminated zone
Control Methods: Minimise - Ensure there is more that one person onsite,
emergency tools are close at hand and required
PPE is worn

F) Ensure correct signage being left onsite for this step is secure and visible

A) Take samples as required
Potential Hazard: Samples may need to be taken in confined spaces and/or contaminated zones
Control Methods: Minimise - Ensure required PPE is worn, there is more than one person onsite and
emergency tools are close at hand. If in confined space refer to

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/area
while treatment is in progress. Check area to ensure none
remain, board up access points so other animals cannot enter
while treatment is in progress

E) Apply surface treatments

F) Set VHP and close up home

G) Ensure correct signage being left onsite for this step is secure and visible

H) Upon re-entry, test VHP levels. Only re-enter if daft to do so
Potential Hazard: Someone enters before it has been deemed safe
Control Methods: Ensure correct hazard signs are on all entry points
and if in doubt wear correct PPE

B) Ensure contaminated material is disposed of in the correct manner
Potential Hazard: Cross-contamination or contamination spreading
Control Methods: Isolate - Ensure contaminated material is contained and
disposed of in the correct manner.

C) Ensure correct signage being left onsite for this step is secure and visible

JOB COMPLETION

STEP 6: Remove signage not being left onsite

STEP 7: Check site and leave

JOB SPECIFICS

WORKS ORDER DETAILS

Claim Number

For Office (Hub)

Requested By

Site Supervisor (Case Manager)

Purchase Order Number

Works Order Number

CLIENT DETAILS

Property is

Owned
Tennanted
Empty
N/A

Access Details (who to call, key given or left, where lockbox location will be etc)

SITE EVACUATION PLAN

EMERGENCY RESPONSE PLAN

In the event of an emergency requiring the shutdown and/or evacuation of the site the following procedure will apply:
1. Notify all persons on site of the emergency.
2. Shutdown all plant and equipment.
3. Proceed immediately to the designated safe assembly point by the safest identifiable route.
4. Remain at the Assembly Point until all persons are accounted for.
5. Do not return to the work site unless authorised by emergency services and/or site supervisor.

In the event of an emergency the SITE SUPERVISOR or designated safety person shall:
1. Ensure all persons are accounted for.
2. Ensure Emergency Services have been called if required.
3. Ensure somebody is assigned to meet emergency services.
4. Notify Main Contractor of the emergency and liaise with Contracts Supervisor as required.
5. Liaise with Emergency Services and Contracts Supervisor prior to returning to work.
6. Ensure the site is safe prior to returning to work.

REPORTING OF INCIDENTS

- All accidents and incidents (events that resulted in or may have resulted in injury or illness) must be reported to Main Contractor and recorded.
- All serious harm and serious near-hits must be fully investigated.
- All serious harm injuries must be reported to the MBIE Labour Group and Main Contractor as soon as possible and within 1 hour.

EMERGENCY CONTACT DETAILS

POLICE FIRE AMBULANCE 111

NEAREST MEDICAL CENTRE

SERIOUS HARM MBIE Labour Group 0800 20 90 20

SPILLS/POLLUTION Environment Canterbury 03 366 4663 (ChchResidential) 0800 75 55 88 (Canterbury Area)

POISONING National Poisons Centre 0800 76 46 66

ANIMAL CONTROL CCC Dog Control 03 941 8999

POWER SUPPLY ISOLATION Orion 0800 363 9898

INITIAL SITE HAZARD REGISTER

The following Hazards have been identified on this site. It is the responsibility of all persons involved with this job to identify any new hazards that may be introduced during the course of the work and to ensure they are added to the register.

POTENTIAL HAZARD OR RISKS (Hazard or Risk Identified)

HAZARD

DESCRIPTION OF POTENTIAL HAZARD OR RISK

IS THIS A SIGNIFICANT HAZARD (Y/N)