Information

  • Client

  • Site / Project

  • Conducted on

  • Prepared By

  • Location

InterCHECK

A. Site Establishment - Housekeeping

  • Is this Section relevant?

  • A1. Is the work area tidy?

  • A2. Is pedestrian access around work site clearly identified and in place?

  • A3. Is the site properly barricaded and isolated from the general public?

  • A4. Are hoses secured, isolated and protected? Are mats in use?

  • A5. Are overhead hazards identified and isolated?

  • A6. Are air hose clamps secured and safety pin in place?

  • A7. Has the site been fully set up as per the requirements nominated in the Traffic Management Plan?

  • A8. Is the Traffic Plan operating effectively?

  • A9. Has the Traffic Management Plan been signed off by the Interflow crew leader and has the Traffic Plan number been recorded on the work pack?

  • A10. Is the Traffic Plan site specific and all relevant fields

B. Documentation

  • Is this section relevant?

  • B1. Has the work pack been signed off by all people on site including subcontractors?

  • B2. Are all controls identified and listed within work pack 2 - Hazard Identification?

  • B3. Have nominated controls for work scope as identified within the work method statement been implemented and identified as working effectively.

  • B4. Is there a Quality, Environment and Safety Management Plan readily available?

  • B5. Does the crew have access to required SDS information?

  • B6. Can crews located an immediate SDS that identifies first aid response or otherwise for chemicals being used?

  • B7. Has the Client control room been notified of the current work activity? Can this be verified?

  • B8. Is a Flow Management plan being used onsite?

  • Is the plan working effectively?

  • B9. Has the Crew Leader completed the daily flow management checklist as required in the flow plan?

  • ADVISE THE CREW LEADER TO STOP WORK - review risks and implemented controls along with complete the required checklist

  • B10. Are Manual Handling controls implemented and working effectively i.e. Use of mechanical aids?

C. Confined Space Entry

  • Is this section relevant?

  • C1. Has the confined space permit been completed?

  • C2. Have all confined space controls as identified on the permit been implemented and identified as working effectively?

  • C3. Can 'Hook-up' (to a rated/ tagged anchor point i.e. Tripod) or 'Cover-up' (security grate covering OPEN access chamber) be positively identified?

  • ADVISE CREW TO STOP WORK AND IMPLEMENT immediate controls to mitigate OPEN ACCESS chamber RISKS

  • C4. Is an SDS readily available (i.e. Access to Chemwatch) for chemicals identified on the confined space permit?

  • C5. Has the Standby person set up a mean of communication with the person in the confined space and emergency services?

  • C6. Has the gas test response 'Bump Test' been recorded on the Entry permit?

  • C7. Is the gas test response bottle in date?

  • C8. Can the crew demonstrate how to complete a bump test?

  • C9. Is ventilation (either natural or forced) implemented in line with the hazard identification checklist (Work pack 2) ?

  • C10. Has all confined space equipment been inspected and validated as being within test and tag currency?

  • C11. Is 'DANGER CONFINED SPACE' signage erected?

  • ADVISE CREW TO STOP WORK AND IMPLEMENT immediate controls to mitigate OPEN ACCESS chamber RISKS

  • C12. Is the Self Rescue Breathing unit available at the confined space?

  • C13. Has the rescue plan rehearsal been recorded on the work pack?

  • C14. Do crew members have individual Confined Space training tickets readily available onsite?

D. Plant and Equipment

  • Is this section relevant?

  • D1. Housekeeping - is all equipment, materials secured / stored correctly on or in the vehicle(s)?

  • D2. Are flammable liquids stored in correct containers and labelled? i.e. de-cantered products

  • D3. Is the fire extinguisher(s) available and verified as current within Test and Tag?

  • Items such as Eyewash need to be verified as not having expired - IF EXPIRED the items are to be replaced immediately, or the kit deemed/ tagged 'unserviceable'.

  • D4. Is the interflow Plant Inspection Checklist(s) available and complete?

  • D5. Is the First Aid kit available and in date ?

  • D6. Has the allocated driver(s) been signed off in the front of the plant checklist?

  • D7. Is the operators drivers license(s) appropriate and current for the vehicle being driven?

  • D8. Are all electrical leads/ RCD's and power tools currently tested and tagged?

  • D9. Are the portable generator sets protected by an RCD?

  • D10. Have lifting chains been Tested and Tagged?

  • D11. Is a tag line being used to direct/ guide equipment when being lifted?

  • D12. IF a Vehicle Loading Crane (VLC) is being used, is the operator trained and has he/she been deemed competent?

  • Select controls implemented by the Operator as evidence of understanding of associated risks

E. Employees

  • Is this section relevant?

  • E1. Is eye protection worn at all times?

  • E2. Are Hard Hats and brims being worn

  • E3. Is hand protection available for use? i.e. attached to self with a clip?

  • Are these gloves serviceable and identified as correct type for task?

  • E4. Is high visibility clothing being worn?

  • E5. Is hearing protection available (on person) and being worn by all at risk? i.e. when jacking this includes the stand by person located above the access chamber

  • E6. Are hand washing facilities available? - Note: this includes both water and appropriate sanitizer/cleaner

  • E7. Is safety footwear in good condition and fastened accordingly?

  • E8. Are P2 masks available and being worn when required?

F. Excavation

  • Is this section relevant

  • F1. Are trenches 1.5m or more in depth benched, battered or shored?

  • F2. Do excavations have barriers or handrails in place to prevent falls?

  • F3. Are ladders secured in excavations and extend out of the excavation by 1m?

  • F4. Is the Excavation edge clear of spoil? i.e. positioned at least 900mm from excavation.

  • F5. Is excavated material protected by silt fencing?

  • F6. Are 25mm thick road plates secured with pins and the leading edge of the plate ramped with cold mix?

  • Does the road plate have and anti-skid surface?

G. Environmental

  • Is this section relevant?

  • G1. Is the Environmental Management Plan available and understood by all?

  • G2. Can fuels be identified as having adequate bunding?

  • G3. Are erosion and sediment control in place eg. Silt Fencing, Sand Bags, Silt Socks etc.?

  • G4. Is contaminated waste collected, disposed of and tracked accordingly?

  • G5. Are Emergency spill kit(s) available?

H. Subcontractor

  • Is this section relevant?

  • H1. Does the subcontractor understand the specific scope of work?

  • H2. Is the Contractor appropriately trained/ or have been deemed competent to complete the task?

  • Tickets and/or qualifications have been verified/Sighted? i.e. Construction Card

  • H3. Has the subcontractor signed onto the work pack and been involved in the Pre-start?

  • H4. Has the subcontractor and/or employees completed the Interflow induction?

  • WORK MUST BE IMMEDIATELY STOPPED - THE SUBCONTRACTOR(S) IS TO BE INDUCTED

I. Training

  • Is this section relevant?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.