Initial Inspection Report & SSSP

• Report for

• Site Address

• Conducted on

  Date

• Prepared By

  Nick Donald

  Jason Pickering

  Clifton Huger

  Harry Thompson

  Tracy Ford

• Personnel Present

  Select Nick Donald Jason Pickering Clifton Huger Harry Thompson Tracy Ford

  • Nick Donald
  • Jason Pickering
  • Clifton Huger
  • Harry Thompson
  • Tracy Ford

INITIAL INSPECTION

• BUILDING TYPE

• The Building Is

  Single Storey

  Two Story

  Three Stories

  > Three Stories

• 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

• The Occupants suffer from

  Select Respiratory Distress Asthma Nose Bleeds Headaches Itchy Eyes Rashes and/or Skin lesions Other No health issues N/A

  • Respiratory Distress
  • Asthma
  • Nose Bleeds
  • Headaches
  • Itchy Eyes
  • Rashes and/or Skin lesions
  • Other
  • No health issues
  • N/A

• Anyone of Specific Concern? (Name)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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

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

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

• Mould is located....

  Select Inside Subfloor Other N/A

  • Inside
  • Subfloor
  • Other
  • N/A

• MOULD INSIDE

• Where inside is the mould located?

• What type of mould exists inside?

• Does mould need to be physically removed?

  Yes

  No

  N/A

• Samples Taken?

  Yes

  No

  N/A

• Date Report Expected Back

  Date

• Photo

  Media

• 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?

  Yes

  No

  N/A

• Samples Taken?

  Yes

  No

  N/A

• Date Report Expected Back

  Date

• Photo

  Media

• OTHER

• Where is the mould located?

• What type of mould exists?

• Does mould need to be physically removed?

  Yes

  No

  N/A

• Samples Taken?

  Yes

  No

  N/A

• Date Report Expected Back

  Date

• Photo

  Media

• SEWERAGE CONTAMINATION

• Where is the possible Sewerage located?

• Does it need to be physically removed?

  Yes

  No

  N/A

• Samples Taken?

  Yes

  No

  N/A

• Date Report Expected Back

  Date

• Photo

  Media

• PUNGENT ODOUR CONTAMINATION

• Where is the pungent odour located?

• Can you identify the source of the odour?

  Yes

  No

  N/A

• Does it need to be physically removed?

  Yes

  No

  N/A

• Samples Taken?

  Yes

  No

  N/A

• Date Report Expected Back

  Date

• Photo

  Media

• OTHER CONTAMINATION

• Describe the contamination

• Where is the contamination located?

• Can you identify the source of the contamination?

  Yes

  No

  N/A

• Does it need to be physically removed?

  Yes

  No

  N/A

• Samples Taken?

  Yes

  No

  N/A

• Date Report Expected Back

  Date

• Photo

  Media

• Comments

POSSIBLE CAUSE

• POSSIBLE CAUSE OF THE PROBLEM

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

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

• Liquefaction

• Presence of liquefaction is

  Minor

  Medium

  Severe

  N/A

• Consistency of Liquefaction is:

  Select Wet Very Wet Slushy Ponding Dry N/A

  • Wet
  • Very Wet
  • Slushy
  • Ponding
  • Dry
  • N/A

• Is liquefaction causing increased moisture levels?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Rising Damp

• Suspected cause of rising damp

  Select Liquefaction LeakingBurst Pipe Lack of DPC Other N/A

  • Liquefaction
  • LeakingBurst Pipe
  • Lack of DPC
  • Other
  • N/A

• Has the cause been fixed yet?

  Yes

  No

  N/A

• Explain/Describe/Photograph Cause

  _

• Water Intrusion

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

  Yes

  No

  N/A

• Was leak caused by a sudden event?

  Yes

  No

  N/A

• Where is/was leak?

• Has leak been fixed?

  Yes

  No

  N/A

• Photo

  Media

• Leaking Water/Drain Pipe

• Was leak caused by a sudden event?

  Yes

  No

  N/A

• Where is/was leak?

• Has leak been fixed?

  Yes

  No

  N/A

• Photo

  Media

REMEDIATION STRATEGY RECOMENDATIONS

• ECC/AIR IMPACT Testing of recommended?

  Yes

  No

  N/A

• Samples Taken?

  Yes

  No

  N/A

• Recommended PPE BEFORE or without decontamination treatment

  Select 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

  • 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)

  Select Inside Subfloor Other N/A

  • Inside
  • Subfloor
  • Other
  • N/A

• Recommended PPE AFTER 'make safe' decontamination treatment

  Select 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

  • 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

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

  Select Inside Subfloor Other N/A

  • Inside
  • Subfloor
  • Other
  • N/A

• Estimated Timeframe for drying....

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

  Yes

  No

  N/A

• Placement and/or replacement of DPM in subfloor recommended?

  Yes

  No

  N/A

• Physical removal of mould most likely required? (Describe)

  Yes

  No

  N/A

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

  Select Inside Subfloor Other N/A

  • Inside
  • Subfloor
  • Other
  • N/A

• Recommended PPE AFTER 'FULL' decontamination treatment

  Select 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

  • 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

CONCLUSION

• Comments

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, Site Hazard Register, Site Induction and sign in register to be used? (Relevant copies attached).

• Location of these Onsite

  Front Door

  Site Entrance

  Trade Vehicle

  Other

• Description of Other Location

• Site Hazard Board to be used?

  Yes

  No

• Location of Hazard Board Onsite

  Select Front Door Site Entrance Trade Vehicle Other

  • Front Door
  • Site Entrance
  • Trade Vehicle
  • Other

• Description of Other Location

• First Aid Kit and Fire Extinguisher Located Onsite

• Location of First Aid Kit and Fire Extinguisher Onsite

  Select Front Door Site Entrance Trade Vehicle Other

  • Front Door
  • Site Entrance
  • Trade Vehicle
  • Other

• Description of Other Location

• Hazardous Substances used on site?

  Yes

  No

• Location of SDS Onsite

  Front Door

  Site Entrance

  Trade Vehicle

  Other

• Location Onsite

  Front Door

  Site Entrance

  Trade Vehicle

  Other

• Description of Other Location

• Description of Other Location

• Any Council Permits Required

  Yes

  No

• List of permits Required

• All hazardous substances listed on Haz. Register

  Yes

  No

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?

  Yes

  No

  N/A

• Task Analysis Attached?

  Yes

  No

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

  Yes

  No

  N/A

• Task Analysis Attached?

  Yes

  No

• 3. Major Demolition work being carried out?

  Yes

  No

  N/A

• Task Analysis Attached?

  Yes

  No

• 4. Use of elevating work platforms required?

  Yes

  No

  N/A

• Task Analysis Attached?

  Yes

  No

• 5. Any working on roofs required?

  Yes

  No

  N/A

• Task Analysis Attached?

  Yes

  No

• 6. Work in confined or restricted spaces required?

  Yes

  No

  N/A

• Task Analysis Attached?

  Yes

  No

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

  Yes

  No

  N/A

• Task Analysis Attached?

  Yes

  No

• 8. Is there any other high risk work?

  Yes

  No

  N/A

• Description of a High Risk work

• Task Analysis Attached?

  Yes

  No

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?

  Yes

  No

  N/A

• Has MBIE Labour Group been notified?

  Yes

  No

  N/A

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

  Sign

• Date

  Date

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

  Select 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

  • 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

ASBESTOS

• Does MBIE Labour Group need to be notified?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• TASK ANALYSIS STEPS

Step

• Description of Step

• For this step I could

  Select 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

  • 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

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

  Eliminate

  Isolate

  Minimize

  N/A

• refer to General Task Analysis for details on common tasks

USE OF ELEVATING WORK PLATFORMS

• Does MBIE Labour Group need to be notified?

  Yes

  No

  N/A

• TASK ANALYSIS STEPS

Step

• Description of Step

• For this step I could

  Select 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

  • 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

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

  Eliminate

  Isolate

  Minimize

  N/A

• refer to General Task Analysis for details on common tasks

WORKING ON ROOFS

• Does MBIE Labour Group need to be notified?

  Yes

  No

  N/A

• TASK ANALYSIS STEPS

Step

• Description of Step

• For this step I could

  Select 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

  • 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

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

  Eliminate

  Isolate

  Minimize

  N/A

• refer to General Task Analysis for details on common tasks

WORKING IN CONFINED/RESTRICTED SPACE

• Does MBIE Labour Group need to be notified?

  Yes

  No

  N/A

• TASK ANALYSIS STEPS

Step

• Description of Step

• For this step I could

  Select 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

  • 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

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

  Eliminate

  Isolate

  Minimize

  N/A

• 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?

  Yes

  No

  N/A

• TASK ANALYSIS STEPS

Step

• Description of Step

• For this step I could

  Select 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

  • 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

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

  Eliminate

  Isolate

  Minimize

  N/A

• refer to General Task Analysis for details on common tasks

OTHER HIGH RISK WORK

• Does MBIE Labour Group need to be notified?

  Yes

  No

  N/A

• 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

  Select 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

  • 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

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

  Eliminate

  Isolate

  Minimize

  N/A

• refer to General Task Analysis for details on common tasks

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

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

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

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

• WORKS ORDER DETAILS

• Claim Number

• For Office (Hub)

• Requested By

• Site Supervisor (Case Manager)

• Purchase Order Number

• Works Order Number

• CLIENT DETAILS

• Property is

  Select Owned Tennanted Empty N/A

  • Owned
  • Tennanted
  • Empty
  • N/A

• 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)

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

• 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>

  Yes

  No

  N/A

• METHOD OF HAZARD CONTROL (Describe)<br>

  Eliminate

  Isolate

  Minimize

  N/A

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

  Nick Donald

  Jason Pickering

  Clifton Huger

  Harry Thompson

  Tracy Ford

• 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)