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

  • Anyone of Specific Concern? (Name)

  • Is there anything in their personal room that one could attribute their problems to?

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

  • Description of Other

  • 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 is located....

  • MOULD INSIDE

  • Where inside is the mould located?

  • What type of mould exists inside?

  • Does mould need to be physically removed?

  • Samples Taken?

  • Date Report Expected Back

  • Photo

  • MOULD IN SUB FLOOR

  • Where in the subfloor is the mould located?

  • What type of mould exists under floor?

  • Does mould need to be physically removed?

  • Samples Taken?

  • Date Report Expected Back

  • Photo

  • OTHER

  • Where is the mould located?

  • What type of mould exists?

  • Does mould need to be physically removed?

  • Samples Taken?

  • Date Report Expected Back

  • Photo

  • SEWERAGE CONTAMINATION

  • Where is the possible Sewerage located?

  • Does it need to be physically removed?

  • Samples Taken?

  • Date Report Expected Back

  • Photo

  • PUNGENT ODOUR CONTAMINATION

  • Where is the pungent odour located?

  • Can you identify the source of the odour?

  • Does it need to be physically removed?

  • Samples Taken?

  • Date Report Expected Back

  • Photo

  • OTHER CONTAMINATION

  • Describe the contamination

  • Where is the contamination located?

  • Can you identify the source of the contamination?

  • Does it need to be physically removed?

  • Samples Taken?

  • Date Report Expected Back

  • Photo

  • Comments

POSSIBLE CAUSE

  • POSSIBLE CAUSE OF THE PROBLEM

  • Liquefaction

  • Presence of liquefaction is

  • Consistency of Liquefaction is:

  • Is liquefaction causing increased moisture levels?

  • Would you recommend the removal of liquefaction? (Explain)

  • Rising Damp

  • Suspected cause of rising damp

  • Has the cause been fixed yet?

  • Explain/Describe/Photograph Cause

  • Water Intrusion

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

  • Was leak caused by a sudden event?

  • Where is/was leak?

  • Has leak been fixed?

  • Photo

  • Leaking Water/Drain Pipe

  • Was leak caused by a sudden event?

  • Where is/was leak?

  • Has leak been fixed?

  • Photo

REMEDIATION STRATEGY RECOMENDATIONS

  • ECC/AIR IMPACT Testing of recommended?

  • Samples Taken?

  • Recommended PPE BEFORE or without decontamination treatment

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

  • Recommended PPE AFTER 'make safe' decontamination treatment

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

  • Estimated Timeframe for drying....

  • Removal of Liquefaction Recomended?<br> (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)

  • Recommended PPE AFTER 'FULL' decontamination treatment

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

  • Location of SSSP Onsite

  • Description of Other Location

  • Site Evacuation Plan (copy attached)

  • Location of Evacuation Plan Onsite

  • Description of Other Location

  • Site Hazard Register (copy attached)

  • Location of Hazard Register Onsite

  • Description of Other Location

  • Site Induction Register to be used?

  • Location Induction Register Onsite

  • Description of Other Location

  • Site Hazard Board to be used?

  • Location of Hazard Board Onsite

  • Description of Other Location

  • Site Sign-In Sheet to be used?

  • Location of Sign-In Sheet Onsite

  • Description of Other Location

  • First Aid Kit Located Onsite

  • Location of First Aid Kit Onsite

  • Description of Other Location

  • Fire Extinguisher Located Onsite

  • Location of Fire Extinguisher Onsite

  • Description of Other Location

  • Any Council Permits Required

  • List of permits Required

  • Hazardous Substances used on site?

  • Location of SDS Onsite

  • Location Onsite

  • Description of Other Location

  • Description of Other Location

  • 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?

  • Task Analysis Attached?

  • 2. Non-Friable asbestos work being carried out?

  • Task Analysis Attached?

  • 3. Major Demolition work being carried out?

  • Task Analysis Attached?

  • 4. Use of elevating work platforms required?

  • Task Analysis Attached?

  • 5. Any working on roofs required?

  • Task Analysis Attached?

  • 6. Work in confined or restricted spaces required?

  • Task Analysis Attached?

  • 7. Work within 4.0m of overhead power lines?

  • Task Analysis Attached?

  • 8. Is there any other high risk work?

  • Description of a High Risk work

  • Task Analysis Attached?

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?

  • Has MBIE Labour Group been notified?

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

  • 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

MAJOR DEMOLITION WORK

  • Does MBIE Labour Group need to be notified?

  • TASK ANALYSIS STEPS

  • Step
  • Description of Step

  • For this step I could

  • Which Control Method I will use (describe how, photo if possible)

  • refer to General Task Analysis for details on common tasks

USE OF ELEVATING WORK PLATFORMS

  • Does MBIE Labour Group need to be notified?

  • TASK ANALYSIS STEPS

  • Step
  • Description of Step

  • For this step I could

  • Which Control Method I will use (describe how, photo if possible)

  • refer to General Task Analysis for details on common tasks

WORKING ON ROOFS

  • Does MBIE Labour Group need to be notified?

  • TASK ANALYSIS STEPS

  • Step
  • Description of Step

  • For this step I could

  • Which Control Method I will use (describe how, photo if possible)

  • refer to General Task Analysis for details on common tasks

WORKING IN CONFINED/RESTRICTED SPACE

  • Does MBIE Labour Group need to be notified?

  • TASK ANALYSIS STEPS

  • Step
  • Description of Step

  • For this step I could

  • Which Control Method I will use (describe how, photo if possible)

  • refer to General Task Analysis for details on common tasks

WORKING WITHIN 4.0M OF OVERHEAD POWERLINES

  • Does MBIE Labour Group need to be notified?

  • TASK ANALYSIS STEPS

  • Step
  • Description of Step

  • For this step I could

  • Which Control Method I will use (describe how, photo if possible)

  • refer to General Task Analysis for details on common tasks

OTHER HIGH RISK WORK

  • 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

  • Which Control Method I will use (describe how, photo if possible)

  • 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 TASK ANALYSIS

  • 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

SUB-FLOOR DECONTAMINATION TREATMENT TASK ANALYSIS

  • 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

DECONTAMINATION OF INTERNAL ENVELOPE

  • 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

  • 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) 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

PHYSICAL CONTAMINATION REMOVAL

  • 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 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

  • Owners Name

  • Owners Contact Details

  • Tenants Name

  • Tenants Contact Details

  • Person to contact for access

  • 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)<br>

  • METHOD OF HAZARD CONTROL (Describe)<br>

  • RESPONSIBILITY (Person/s responsible for ensuring controls are implemented)<br><br>

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.

  • HAZARD

  • POTENTIAL HAZARD OR RISK (Hazard or Risk Identified)


  • SIGNIFICANT HAZARD (Y/N)

  • METHOD OF HAZARD CONTROL (Eliminate, Isolate, Minimise)

  • DESCRIPTION OF METHOD OF HAZARD CONTROL


  • RESPONSIBILITY (Person/s responsible for ensuring controls are implemented)


  • HAZARD

  • POTENTIAL HAZARD OR RISK (Hazard or Risk Identified)


  • SIGNIFICANT HAZARD (Y/N)

  • METHOD OF HAZARD CONTROL (Eliminate, Isolate, Minimise)

  • DESCRIPTION OF METHOD OF HAZARD CONTROL


  • RESPONSIBILITY (Person/s responsible for ensuring controls are implemented)


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