INTERFLOW - Workplace Verification

• Client

  Select Queensland Urban Utilities Unity Water Watercorp Sydney Water Gold Coast City Council Other

  • Queensland Urban Utilities
  • Unity Water
  • Watercorp
  • Sydney Water
  • Gold Coast City Council
  • Other

• Site / Project

• Conducted on

  Date

• Prepared By

• Location
  Address

• Enter address if not identified

• Is this section relevant?

Safety Conversation

• Safety Share/ Safety Alerts or L2BL communicated

Personnel Details

• Identified Workgroup

  Select Lining Crew Cutting Crew Dig Up Crew Cleaning Crew Subcontractor Other Interfit

  • Lining Crew
  • Cutting Crew
  • Dig Up Crew
  • Cleaning Crew
  • Subcontractor
  • Other
  • Interfit

• SNRP Details

• Interflow Worker(s) Details

• Contractor(s) Details

Work Pack Risk Assessment

• All roles and responsibilities have been identified and are understood?

  Yes

  No

  N/A

• Work Pack has been completed in full consultation with all - includes Subcontractors i.e. Traffic Controllers?

  Yes

  No

  N/A

• Work Method Statements have been correctly identified for the scope of work and can be validated as having been reviewed in full by all members of the work group

  Yes

  No

  N/A

Identify any High Risk Work Activities and verify controls have been implemented adequately to mitigate RISK

• Select Confined Space Entry Excavation and Trenching Electrical Safety Use of Hazardous Chemicals Working at Height Hazardous Manual Tasks - i.e. Lifting and Pulling Use of Plant and Equipment - i.e. Vehicle Loading Crane (VLC) Working Adjacent to the Roadway - Traffic Management Energy Isolation - Lock Out/ Tag Out Working Adjacent to Water Lone Worker Demolition Works Scaffolding Asbestos Removal or Handling Use of High Pressure Equipment

  • Confined Space Entry
  • Excavation and Trenching
  • Electrical Safety
  • Use of Hazardous Chemicals
  • Working at Height
  • Hazardous Manual Tasks - i.e. Lifting and Pulling
  • Use of Plant and Equipment - i.e. Vehicle Loading Crane (VLC)
  • Working Adjacent to the Roadway - Traffic Management
  • Energy Isolation - Lock Out/ Tag Out
  • Working Adjacent to Water
  • Lone Worker
  • Demolition Works
  • Scaffolding
  • Asbestos Removal or Handling
  • Use of High Pressure Equipment

• Additional Notes on Implemented Controls

Photos

• Add media

  Media

• Is this Section relevant?

A. Site Establishment - Housekeeping

• Is this Section relevant?

• A1. Is the work area tidy?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• A4. Are overhead hazards identified and isolated?

  Safe

  At Risk

  N/A

• A5. Are hoses secured, isolated and protected? Are mats in use?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• A8. Is the Traffic Plan operating effectively?

  Safe

  At Risk

  N/A

• 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?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

B. Documentation

• Is this section relevant?

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• B5. Does the crew have access to required SDS information (Chemwatch or Hardcopy)?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Is the plan working effectively?

  Yes

  No

  N/A

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

  Safe

  At Risk

  N/A

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

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

  Safe

  At Risk

  N/A

C. Confined Space Entry

• Is this section relevant?

• C1. Has the confined space permit been completed?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

• C4. Is an SDS readily available for chemicals identified on the confined space permit? This may be accessible via Chemwatch or be a hard copy.

  Safe

  At Risk

  N/A

• C5. Has the Standby person established a means of communication with the person in the confined space and emergency services?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• 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?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

D. Plant and Equipment

• Is this section relevant?

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• 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'.

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• D10. Have lifting chains been Tested and Tagged?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Select Signage Identified Exclusion Zone Use of a Spotter Use of communication - Two way/ Hand Signals Prestart check performed on VLC All lifting equipment has been verfied as currently tested and tagged Crane outriggers have been deployed and postioned onto Dunnage Tag line is being used Understanding of COP Approach Distances to 'overhead assets'

  • Signage
  • Identified Exclusion Zone
  • Use of a Spotter
  • Use of communication - Two way/ Hand Signals
  • Prestart check performed on VLC
  • All lifting equipment has been verfied as currently tested and tagged
  • Crane outriggers have been deployed and postioned onto Dunnage
  • Tag line is being used
  • Understanding of COP Approach Distances to 'overhead assets'

E. Employees

• Is this section relevant?

• E1. Is eye protection worn at all times?

  Safe

  At Risk

  N/A

• E2. Are Hard Hats and brims being worn

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• E4. Is high visibility clothing being worn? If Night work......appropriate PPE?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

F. Excavation

• Is this section relevant

• F1. Are trenches 1.5m or more in depth benched, battered, shored or supported by a Geotechnical Survey?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• F5. Is excavated material protected by silt fencing?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

G. Environmental

• Is this section relevant?

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

  Safe

  At Risk

  N/A

• G2. Are erosion and sediment control in place eg. Silt Fencing, Sand Bags, Silt Socks etc.?

  Safe

  At Risk

  N/A

• G3. Is contaminated waste collected, disposed of and tracked accordingly?

  Safe

  At Risk

  N/A

• G4. Are Emergency spill kit(s) available?

  Safe

  At Risk

  N/A

• G5. Are all identified fuels bunded correctly when stored?

  Safe

  At Risk

  N/A

H. Subcontractor

• Is this section relevant?

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

• H3. Has the subcontractor signed onto the work pack or the site induction record?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

I. Training

• Is this section relevant?

• 1.1 Does the Crew Leader/ Foreman have a copy of the Site Management SOP readily available?

  Safe

  At Risk

  N/A

• 1.2 Has the Crew Leader been audited on the Site Management SOP?

  Safe

  At Risk

  N/A

• Is this type of Workplace Verification relevant?

1. Monthly Focus

• Is this section relevant?

• Add media

  Media

2. Office and Amenities

• Is this section relevant?

• 1. Is there an established Safety Notice board/ relevant information displayed?

  Safe

  At Risk

  N/A

• 2. Are appointed persons names/ Photos displayed i.e. Safety Reps, First Aiders, Fire Wardens etc.?

  Safe

  At Risk

  N/A

• 3. Fire Extinguishers available and correctly identified?

  Safe

  At Risk

  N/A

• 4. Access to fire extinguishers is unobstructed?

  Safe

  At Risk

  N/A

• 5. Exits are cleared/ unobstructed and signs are appropriately illuminated?<br>

  Safe

  At Risk

  N/A

• 6. All office materials stored correctly out of walkways?

  Safe

  At Risk

  N/A

• 7. Bins are provided and emptied (included separation i.e. Recycle)?<br>

  Safe

  At Risk

  N/A

• 8. Kitchen area clean and tidy?<br>

  Safe

  At Risk

  N/A

• 9. All building electrical equipment (inclusive of power boards) is in good working order supported by current Test and Tag?

  Safe

  At Risk

  N/A

• 10. Toilets clean and tidy, hand wash, soap, paper towel supplied?

  Safe

  At Risk

  N/A

• 11. Tops of cabinets or shelves adjacent to walkways are clear of items that may fall.

  Safe

  At Risk

  N/A

• 12. Waste segregation measures in place & containers labelled

  Safe

  At Risk

  N/A

• 13. Has and Emergency Response drill been conducted within the last 12 months?

  Safe

  At Risk

  N/A

3. First Aid and Facilities

• Is this section relevant?

• 1. Current first aid equipment list available in cabinet?

  Safe

  At Risk

  N/A

• 2. Contents useable and within use by dates?

  Safe

  At Risk

  N/A

• 3. Emergency procedures / phone numbers displayed?

  Safe

  At Risk

  N/A

• 4. Trained First Aid personnel identified for crews and within office areas?

  Safe

  At Risk

  N/A

• 5. First Aid equipment easily identified/ located?

  Safe

  At Risk

  N/A

• 6. First Aid equipment is stored correctly i.e. Wall mounted/ vehicle box?

  Safe

  At Risk

  N/A

• 7. Medical waste disposed of correctly? i.e. Sharps container

  Safe

  At Risk

  N/A

• 8. Has the project identified and setup a local Medical Provider i.e. Sonic Health Plus, has this information been communicated?

  Safe

  At Risk

  N/A

4. Workshop and Store

• Is this section relevant?

• 1. Work areas tidy?

  Safe

  At Risk

  N/A

• 2. Regular disposal of waste/ Segregation identified?

  Safe

  At Risk

  N/A

• 3. Walkways unobstructed?

  Safe

  At Risk

  N/A

• 4. Adequate lighting for the work being carried out?

  Safe

  At Risk

  N/A

• 5. Sharp objects covered / protected?

  Safe

  At Risk

  N/A

• 6. Fire extinguishers identified, checked, unobstructed?<br>

  Safe

  At Risk

  N/A

• 7. RCD’s on all electrical equipment?

  Safe

  At Risk

  N/A

• 8. All electrical equipment serviceable with current with Test and Tag?

  Safe

  At Risk

  N/A

• 9. Tools and equipment identified as serviceable and stored correctly?

  Safe

  At Risk

  N/A

• 10. Authorized guarding fitted to equipment i.e. Grinder/ Barrel Cutter?

  Safe

  At Risk

  N/A

• 11. Sparks contained / welding screens used?

  Safe

  At Risk

  N/A

• 12. PPE available/ serviceable and correct for task?

  Safe

  At Risk

  N/A

• 13. Materials stored correctly i.e. Flammables in fire proof cabinet, segregation and compatibility considered?

  Safe

  At Risk

  N/A

• 14. Tools and equipment correct for the task?

  Safe

  At Risk

  N/A

• 15. Spill kits available?

  Safe

  At Risk

  N/A

• 16. Dust mitigation in area?

  Safe

  At Risk

  N/A

• 17. Bunding and/or storage of HAZ materials/ substances considered?

  Safe

  At Risk

  N/A

5. Housekeeping and Access and Egress

• Is this section relevant?

• 1. Materials stacked safely and correctly?

  Safe

  At Risk

  N/A

• 2. Laydown areas defined clean and tidy?

  Safe

  At Risk

  N/A

• 3. Signage erected to identify hazardous storage / disposal area?

  Safe

  At Risk

  N/A

• 4. Signs and barricading erected and maintained around worksite or identified hazardous area?

  Safe

  At Risk

  N/A

• 5. Solid barricading erected and maintained around potential fall areas and complies with legislative requirement?

  Safe

  At Risk

  N/A

• 6. Sharp objects capped i.e. star pickets, rebar, tools?

  Safe

  At Risk

  N/A

• 7. General housekeeping standard is being maintained?

  Safe

  At Risk

  N/A

• 8. Bin locations prominent, adequate and emptied regularly?

  Safe

  At Risk

  N/A

• 9. Access and egress points clear of obstruction?

  Safe

  At Risk

  N/A

• 10. Access to elevated work areas complies with site requirements?

  Safe

  At Risk

  N/A

• 11. Handrails installed on ramps & stairs etc. where applicable?

  Safe

  At Risk

  N/A

• 12. Ladders industrial when required are secured, 1 to 4 meter lean, the ladder projects 1 meter above the platform?

  Safe

  At Risk

  N/A

6. Fall Prevention

• Is this section relevant?

• 1. All fall prevention equipment recorded on a register?

  Safe

  At Risk

  N/A

• 2. All fall protection equipment is currently Tested and Tagged?

  Safe

  At Risk

  N/A

• 3. Equipment in sound condition, free of visible damage?

  Safe

  At Risk

  N/A

• 4. Range of equipment available is adequate for the work scope and is correctly set up?

  Safe

  At Risk

  N/A

• 5. Equipment has been inspected prior to use by a competent person?

  Safe

  At Risk

  N/A

• 6. WMS correctly identified, is specific for the task and understood by all?

  Safe

  At Risk

  N/A

• 7. Personnel are trained and current in the use of equipment?

  Safe

  At Risk

  N/A

• 8. Fall arrest systems installed and being operated by an identified competent person?

  Safe

  At Risk

  N/A

• 9. Anchor point /s comply with safety requirements?

  Safe

  At Risk

  N/A

• 10. Safety harness stored correctly when not used i.e. within a PPE storage bag?

  Safe

  At Risk

  N/A

• 11. Safety harness fitted correctly for purpose i.e. not loose?

  Safe

  At Risk

  N/A

7. Confined Space Entry

• Is this section relevant?

• 1. Permit is Valid & Authorized?

  Safe

  At Risk

  N/A

• 2. Person/s Trained and deemed competent to enter Confined Space?

  Safe

  At Risk

  N/A

• 3. Pre-Start documentation, WMS, Procedure, Drawings etc. readily available?

  Safe

  At Risk

  N/A

• 4. All identified controls have been implemented and communicated?

  Safe

  At Risk

  N/A

• 5. Equipment flushed, purged, bump tested?

  Safe

  At Risk

  N/A

• 6. Alternate entry points secured?

  Safe

  At Risk

  N/A

• 7. Equipment depressurized / drained?

  Safe

  At Risk

  N/A

• 8. Extraction / forced ventilation plan authorized, discussed and communicated amongst all?

  Safe

  At Risk

  N/A

• 9. Emergency response requirements - Rescue plan in place/ all contact numbers available and discussed?

  Safe

  At Risk

  N/A

• 10. Exclusion zone, barricading and signage set up inclusive of SPECIFIC Confined Space signage?

  Safe

  At Risk

  N/A

• 11. Lighting - Low voltage lighting installed & functional?

  Safe

  At Risk

  N/A

• 12. Entry / exit log in place and completed?

  Safe

  At Risk

  N/A

• 13. Initial atmospheric test conducted?

  Safe

  At Risk

  N/A

• 14. Standby person/ Rescuer identified in place, trained, understands responsibilities?

  Safe

  At Risk

  N/A

• 15. Breathing apparatus available? Is the CSE person/s remaining attached? Has this been considered?

  Safe

  At Risk

  N/A

• 16. Rescue equipment currently tagged and tested i.e. Tripod?

  Safe

  At Risk

  N/A

• 17. Fit for work (inclusive of immunization status - particularly if entering Sewer) has been considered by all involved in work scope?

  Safe

  At Risk

  N/A

• 18. PPE requirements identified & complied with?

  Safe

  At Risk

  N/A

• 19. Communications in place, suitable and understood by all?

  Safe

  At Risk

  N/A

8. Lifting Equipment

• Is this section relevant?

• 1. All lifting equipment recorded on a register?<br>

  Safe

  At Risk

  N/A

• 2. PPE correct for task?

  Safe

  At Risk

  N/A

• 3. Safe working loads marked on all lifting equipment?

  Safe

  At Risk

  N/A

• 4. Equipment is clearly identified as being within current Test and Tag i.e. Appropriate colour tag/ date displayed?<br>

  Safe

  At Risk

  N/A

• 5. Equipment stored appropriately, hung, vented, out of UV direct etc.?

  Safe

  At Risk

  N/A

• 6. All Lifting Equipment has been inspected prior to use and has been identified as being fit for purpose and in good condition?

  Safe

  At Risk

  N/A

• 7. Slings adequately protected i.e. packing?<br>

  Safe

  At Risk

  N/A

• 8. Tag lines used on all loads (16mm natural fiber rope), to ensure that the persons remain out of the 'LINE OF FIRE'?

  Safe

  At Risk

  N/A

• 9. WMS/ Pre-Start (RA) process reflects work scope?

  Safe

  At Risk

  N/A

• 10. Person(s) qualified to use equipment i.e. Dogger/ Rigger?

  Safe

  At Risk

  N/A

• 11. Round soft slings not being used as head slings or temporary support of pipes etc.?

  Safe

  At Risk

  N/A

• 12. Round soft slings not used for lifting other than pipework?

  Safe

  At Risk

  N/A

9. Cranes

• Is this section relevant?

• 1. Exclusion zone established around slew area, proximity to overhead considered/ exclusion zones understood?

  Safe

  At Risk

  N/A

• 2. Outriggers fully extended on timber/composite support/ packed as per manufacturers specifications/ engineers recommendations and are protected from traffic disturbance by a physical barrier and applicable signage?

  Safe

  At Risk

  N/A

• 3. Adequate ground bearing support / level surface clear of excavations and/or evidence of subsidence?

  Safe

  At Risk

  N/A

• 4. Daily inspection checklist completed / safety devices checked/ load charts available and being used?

  Safe

  At Risk

  N/A

• 5. Crane Operators / Riggers communication methods i.e. whistle/ hand signals are clear?

  Safe

  At Risk

  N/A

• 6. Operators Manual located within the crane?

  Safe

  At Risk

  N/A

• 7. Chains removed / secured in preparation for travelling?

  Safe

  At Risk

  N/A

• 8. Lift Plan/ Log and or evaluation completed by operator?

  Safe

  At Risk

  N/A

• 9. Rigger / Dog-man carrying out spotters duties as required eg interface with moving load & personnel

  Safe

  At Risk

  N/A

• 10. Man-cage permit in place & complied with Man Cage Tested and Tagged?

  Safe

  At Risk

  N/A

• 11. Spill kit readily available or located on the crane?

  Safe

  At Risk

  N/A

• 12. Crane Certification observed i.e. Crane Safe Sticker?

  Safe

  At Risk

  N/A

• 13. If a Contractor has the Safe Work System been Validated/ accepted by Interflow?

  Safe

  At Risk

  N/A

• 14. Slings, chains, hooks, Shackles and eyes are certified and within Test and Tag?

  Safe

  At Risk

  N/A

10. Scaffolding

• Is this section relevant?

• 1. Scaff-tag placed at all access points and clearly visible?

  Safe

  At Risk

  N/A

• 2. Access built to AS/COP requirements?

  Safe

  At Risk

  N/A

• 3. Scaffold has been inspected within the 30 day inspection period or otherwise as required?

  Safe

  At Risk

  N/A

• 4. Competent person erecting / modifying / dismantling?

  Safe

  At Risk

  N/A

• 5. Where erecting, modifying or dismantling area below is and exclusion zone and appropriately barricaded & sign posted?

  Safe

  At Risk

  N/A

• 6. All working platforms are fully planked & secured?

  Safe

  At Risk

  N/A

• 7. Handrail, Mid-rail & toe board fitted?

  Safe

  At Risk

  N/A

• 8. Ladder(s) project 1 meter above the landing platform and is secured?

  Safe

  At Risk

  N/A

• 9. Erect / dismantle – Harness & lanyards used correctly?

  Safe

  At Risk

  N/A

• 10. Ladder safety rail fitted to access?

  Safe

  At Risk

  N/A

• 11. WMS/ Pre-start or RA accurately reflects work scope?

  Safe

  At Risk

  N/A

• 12. Scaffold materials stored in a safe manner?

  Safe

  At Risk

  N/A

• 13. Mesh screen fitted where objects may be dislodged?

  Safe

  At Risk

  N/A

11. Electrical Equipment

• Is this section relevant?

• 1. Leads are elevated above ground by non conductive support / material?

  Safe

  At Risk

  N/A

• 2. Leads not obstructing access and egress ways?

  Safe

  At Risk

  N/A

• 3. Are lead plugs in sound condition (no exposed wires) etc. labelled correctly and identified as current with T&T? <br>i.e. Red (Jan, Feb, Mar) / Green (Apr, May, Jun) / Blue (Jul, Aug, Sep) / Yellow (Oct, Nov, Dec)

  Safe

  At Risk

  N/A

• 4. Leads not secured or tied off directly to scaffolding or handrails?

  Safe

  At Risk

  N/A

• 5. Are all connection ends and plugs are clean and fitting correctly?

  Safe

  At Risk

  N/A

• 6. All portable electrical tools are energized through an RCD that is currently within T&T?

  Safe

  At Risk

  N/A

• 7. 240V leads do not exceed 30m in length?

  Safe

  At Risk

  N/A

• 8. Double adapters/ Piggy back plugs not being used?

  Safe

  At Risk

  N/A

• 9. All electrical equipment is being stored correctly when not in use i.e. out of the weather?

  Safe

  At Risk

  N/A

• 10. Are Switchboards/ RCD's correctly labelled?

  Safe

  At Risk

  N/A

• 11. If live work is being performed, is this duly authorized and under permit?

  Safe

  At Risk

  N/A

12. Mobile Plant

• Is this section relevant?

• 1. Can you Identify the Plant by Registration or Serial Number?

  Safe

  At Risk

  N/A

• 2. Has a Daily pre start inspection checklist completed by operator?

  Safe

  At Risk

  N/A

• 3. Is the operator appropriately licensed / Deemed competent to operate the plant?

  Safe

  At Risk

  N/A

• 4. If faults are identified have these been accurately reflected on the Vehicle Checklist?

  Safe

  At Risk

  N/A

• 5. Can Operator licenses/ competencies be verified on an internal register?

  Safe

  At Risk

  N/A

• 6. Are safety devices and warning signals fitted and in good condition – i.e. First Aid Kit/ Fire Extinguishers / Spill kit / reverse alarms / seat belts / beacon etc.?

  Safe

  At Risk

  N/A

• 7. When not in use the Plant is appropriately parked up i.e. Home garaged/ In designated parking area/ At Depot?

  Safe

  At Risk

  N/A

• 8. Have noise impacts been considered?

  Safe

  At Risk

  N/A

• 9. Has dust mitigation been considered?

  Safe

  At Risk

  N/A

13. Employee Conduct

• Is this section relevant?

• 1. Sound communication amongst all on site inclusive of Sub-contractors?

  Safe

  At Risk

  N/A

• 2. Does the Employee understand that they are empowered to step back and reassess if required?

  Safe

  At Risk

  N/A

• 3. Is the employee aware of the reporting requirements in the event of an incident?

  Safe

  At Risk

  N/A

• 4. No throwing / dropping tools or equipment, materials arranged/ organized, personal/ construction waste considered?

  Safe

  At Risk

  N/A

• 5. Right Tool for the Right job being considered?

  Safe

  At Risk

  N/A

• 6. Tools and equipment are being used appropriately?

  Safe

  At Risk

  N/A

• 7. Individual job planning/ Risk management evident i.e. Work Pack completion?

  Safe

  At Risk

  N/A

• 8. Employee considers all risks associated with Falling from, being exposed to, caught between and/ or struck by anything onsite and has implemented controls for protection.

  Safe

  At Risk

  N/A

14. WMS/ Task Based Risk Assessment

• Is this section relevant?

• 1. Is a WMS applicable for the scope of work? (Include Sub-contractors) - Has it been authorized and Reviewed?

  Safe

  At Risk

  N/A

• 2. Crew Lead/ Construction Manager has verified throughout the day that work methods are in accordance with the WMS/ Work Pack?

  Safe

  At Risk

  N/A

• 3. Has the work-pack/ Pre-start been completed collectively, Inclusive of Subcontractors?

  Safe

  At Risk

  N/A

• 4. Have the WMS's been developed/ reviewed and agreed upon by all 'Consultative'? Note last review date

  Safe

  At Risk

  N/A

• 5. Have all controls identified via HazID (Recon) / within the WMS/ or as identified within the Prestart (Work Pack 2) been implemented?

  Safe

  At Risk

  N/A

• 6.<br>Work Pack Information i-Pad/ Box etc. readily accessible at the site/ work location contains - Permit(s), WMS, Procedures, SDS's, drawings, ITP's etc.?

  Safe

  At Risk

  N/A

• 7. Have all emergency requirements been clearly identified and communicated via Prestart/ Work Pack process?

  Safe

  At Risk

  N/A

15. Permit to Work

• Is this section relevant?

• 1. Has the correct permit been selected for the task e.g. Excavation and Trenching, Confined Space Entry, Work at Height, Traffic Management etc.?

  Safe

  At Risk

  N/A

• 2. Is the task identified on the permit in line with observed work scope?

  Safe

  At Risk

  N/A

• 3. Can all required certificates and supporting documentation to support the permit be readily accessed?

  Safe

  At Risk

  N/A

• 4. Is the issued Permit appropriately authorized?

  Safe

  At Risk

  N/A

• 5. Has the permit been altered/ changed or marked up?

  Safe

  At Risk

  N/A

• 6. Is the permit within the validity period

  Safe

  At Risk

  N/A

• 7. Has the permit been revalidated/relinquished? Verify Dates

  Safe

  At Risk

  N/A

• 8. Is the permit (i.e. Confined Space Permit) located within the vicinity of the CS or the work group on site?

  Safe

  At Risk

  N/A

• 9. Have all controls been communicated/ understood and/ implemented by all?

  Safe

  At Risk

  N/A

• 10. All persons required to work under the permit have been trained and deemed competent?

  Safe

  At Risk

  N/A

• 11. Can all those working under the permit be identified as having reviewed SOP's/ WMS?

  Safe

  At Risk

  N/A

16. Hazardous Substances

• Is this section relevant?

• 1. Readily available access to SDS information, i.e. Chem-Watch on Tablet?

  Safe

  At Risk

  N/A

• 2. Identified persons have been trained and deemed competent to access SDS information on Chem-Watch i.e. Mini SDS?

  Safe

  At Risk

  N/A

• 3. Are training records available for personnel using or handling hazardous substances? i.e. familiarization/ awareness training.

  Safe

  At Risk

  N/A

• 4. Segregation considered on vehicle or in store / warning signs displayed as applicable?

  Safe

  At Risk

  N/A

• 5. Emergency equipment adequate and available ie. Spill containment?

  Safe

  At Risk

  N/A

• 6. All containers are correctly labelled if De-cantered?

  Safe

  At Risk

  N/A

• 7. Are risk control measures been implemented and understood by all?

  Safe

  At Risk

  N/A

• 8. Are adequate first aid facilities available i.e. First Aid Kit/ Eye wash?

  Safe

  At Risk

  N/A

• 9. Ventilation adequate to remove and maintain atmospheric levels below exposure limits?

  Safe

  At Risk

  N/A

• 10. Are Hazardous substances being disposed off correctly?

  Safe

  At Risk

  N/A

• 11. 3m clearance maintained around storage area?

  Safe

  At Risk

  N/A

• 12. All packages are closed while not in use?

  Safe

  At Risk

  N/A

• 13. Spillage retention measures adopted where containers are opened for transfer? i.e. temp bund

  Safe

  At Risk

  N/A

17. Welding/ Hot Work

• Is this section relevant?

• 1. Task based RA completed along with permit in place for work scope?

  Safe

  At Risk

  N/A

• 2. Serviceable Fire extinguisher located in close proximity?

  Safe

  At Risk

  N/A

• 3. Sparks / hot metal particles contained?

  Safe

  At Risk

  N/A

• 4. Is the correct PPE being worn for the task/

  Safe

  At Risk

  N/A

• 5. Welding screens and fire blankets in place?

  Safe

  At Risk

  N/A

• 6. Is waste being disposed of correctly, i.e used welding rods?

  Safe

  At Risk

  N/A

• 7. Leads / hoses routed in a safe manner?

  Safe

  At Risk

  N/A

• 8. Grinders used in accordance with procedures? Handles fitted?

  Safe

  At Risk

  N/A

• 9. All combustible materials are separated from the hot work area?

  Safe

  At Risk

  N/A

• 10. Cylinders secured, gauges operative, flashback arresters fitted and hoses in good condition?

  Safe

  At Risk

  N/A

• 11. Is double eye protection used when welding/ Grinding or Oxy Cutting?

  Safe

  At Risk

  N/A

• 12. Is the work-crew aware of monitoring requirement post work?

  Safe

  At Risk

  N/A

• 13. Welding leads/ oxy hoses/ Flash arresters inspected and tagged accordingly?

  Safe

  At Risk

  N/A

18. Excavations

• Is this section relevant?

• 1. Has the Emergency Response Plan been considered and fully communicated as part of the Pre-start?

  Safe

  At Risk

  N/A

• 2. Excavation Permit is Valid & Authorised - Fully complete?

  Safe

  At Risk

  N/A

• 3. All identified controls have been implemented and communicated?

  Safe

  At Risk

  N/A

• 4. WMS, DBYD, Drawings etc. readily available?

  Safe

  At Risk

  N/A

• 5. IF SERVICES i.e. GAS/ POWER/ TELCOMMUNICATION are identified, have these been POSITIVELY LOCATED?

  Yes

  No

  N/A

• ENSURE WORKERS STOP WORK!!!! - NON DESTRUCTIVE STEPS (i.e. Potholing by hand) ARE TO BE TAKEN TO POSITIVELY LOCATE THE ASSET - IF NOT POSSIBLE ELEVATE TO SUPERVISOR/ FOREMAN

• 6. Safe Access & egress considered?

  Safe

  At Risk

  N/A

• 7. Is the excavations > 1.5 in depth? Is it Bench, Battered, Shored?

  Safe

  At Risk

  N/A

• 8. If greater than 1.5m in depth and Benched, Battering or Shoring is not identified has the site been Geotechnical Surveyed?

  Yes

  No

  N/A

• ENSURE THAT ALL WORK IS STOPPED AND THAT CONTROLS ARE IMMEDIATELY IMPLEMENTED

• 9. Barricading & Signage maintained to a high standard - taut and level position,<br>< 1.5m flagging & hard barricade or otherwise.....<br>> 1.5m Danger flagging & hard barricading with 'Danger Deep Excavation' Signage displayed

  Safe

  At Risk

  N/A

• 10. Has a Spotter Requirement been identified (i.e. electrical)?

  Safe

  At Risk

  N/A

• 11. When using machine after POSITIVELY IDENTIFYING services are excavation scrapes greater than 100mm?

  Safe

  At Risk

  N/A

19. Lighting/ Nightshift

• Is this section relevant?

• 1. Lighting/ illumination of all designated work areas adequate?

  Safe

  At Risk

  N/A

• 2. Provided on or in vicinity of operating/ moving machinery?

  Safe

  At Risk

  N/A

• 3. Excavations well lit where required considerations for slip, trip, fall?

  Safe

  At Risk

  N/A

• 4. Laydown/ equipment storage area/ yard?

  Safe

  At Risk

  N/A

• 5. Car park area adequately illuminated?

  Safe

  At Risk

  N/A

• 6. Provided to all scaffolding platforms in use.

  Safe

  At Risk

  N/A

• 7. If performing Night Work is PPE the correct type?

  Safe

  At Risk

  N/A

20. Environment

• Is this section relevant?

• 1. The Environmental Management Plan is readily available and understood?

  Safe

  At Risk

  N/A

• 2. Spill kits/ Socks/ Coil logs/ Silt fencing etc. for sediment and erosion control available and installed as required?

  Safe

  At Risk

  N/A

• 3. Spills reported and cleaned up/ waste disposed of and tracked accordingly?

  Safe

  At Risk

  N/A

• 4. Impacts on Flora and Fauna minimized

  Safe

  At Risk

  N/A

• 5. All Plant and Equipment is serviceable and free of oil drips / seepage?

  Safe

  At Risk

  N/A

• 6. Appropriate waste disposal containers available?

  Safe

  At Risk

  N/A

• 7. Waste segregation measures i.e. Re-cycle in place & containers labelled?

  Safe

  At Risk

  N/A

• 8. Hazardous waste disposed of appropriately?

  Safe

  At Risk

  N/A

• 9. Are water drains protected from construction materials?

  Safe

  At Risk

  N/A

• 10. Are weeds being proliferated? Do we have wash-down responsibilities if so are 'Weed Declarations' available?

  Safe

  At Risk

  N/A

• 11. Dust control measures?

  Safe

  At Risk

  N/A

• 12. Overall Housekeeping

  Safe

  At Risk

  N/A

• 13. Noise levels are monitored and controlled, impact on residents?

  Safe

  At Risk

  N/A

21. Driving Safety

• Is this section relevant?

• 1. Has the driver been trained and assessed as competent for the vehicle being driven? Is the person appropriately licensed?

  Safe

  At Risk

  N/A

• 2. Is the vehicle fitted with an In Vehicle Monitoring System?

  Yes

  No

  N/A

• 3. Has the Driver competed a full vehicle pre-inspection prior to operation?

  Safe

  At Risk

  N/A

• 4. Is the vehicle fitted with operational reversing beeper?

  Safe

  At Risk

  N/A

• 5. Is the vehicle fitted with an operational in date fire extinguisher?

  Safe

  At Risk

  N/A

• 6. Is the vehicle fitted with a First Aid Kit?

  Safe

  At Risk

  N/A

• 7. Is the vehicle suitable for identified Site conditions?

  Safe

  At Risk

  N/A

• 8. Is the vehicle complying with manufacturer's personnel carrying requirements.

  Safe

  At Risk

  N/A

• 9. Do personnel wear seatbelts? Are they serviceable?

  Safe

  At Risk

  N/A

• 10. Does the vehicle contain a Spill Kit?

  Safe

  At Risk

  N/A

22. Electrical Isolations

• Is this section relevant?

• 1. If electrical work is subcontracted, is this being performed by a licensed/ competent person who has been adequately on-boarded?

  Safe

  At Risk

  N/A

• 2. Electrical work performed under permit? Has the permit been authorized?

  Safe

  At Risk

  N/A

• 3. A test for zero energy has been conducted by a Competent Persons prior to commencing work.

  Safe

  At Risk

  N/A

• 4. Working on live conductors assessed as the only practicable solution and approved.

  Safe

  At Risk

  N/A

• 5. Minimum of 2 persons when working on live exposed conductors.

  Safe

  At Risk

  N/A

• 6. Isolation Authorities have been designated and approved

  Safe

  At Risk

  N/A

• 7. All isolations verified by Competent Persons.

  Safe

  At Risk

  N/A

• 8. Isolations are locked and tagged.

  Safe

  At Risk

  N/A

• 9. De-isolations are conducted by Competent Persons.

  Safe

  At Risk

  N/A

23. Earthmoving

• Is this section relevant?

• 1. Has placement of material been considered? (face thickness for batters, angle of repose etc.)?

  Safe

  At Risk

  N/A

• 2. Is there enough area for safe and productive operation (vehicle interaction) of machines?

  Safe

  At Risk

  N/A

• 3. Is the equipment being used correctly for task/ work scope?

  Safe

  At Risk

  N/A

• 4. Is access to the work area appropriate (Congestion, close proximity to other vehicles)?

  Safe

  At Risk

  N/A

• 5. Is access to the work area clearly sign-posted, barricaded and delineated?

  Safe

  At Risk

  N/A

• 6. Is entry being controlled (Warning and no entry signs, security etc.)?

  Safe

  At Risk

  N/A

• 7. Is there observed over loading leading to spillage?

  Safe

  At Risk

  N/A

• 8. Is there adequate positive communication to perform the task safely? (Radios and or spotters or use of Hand Signals)

  Safe

  At Risk

  N/A

• 9. Is there adequate and appropriate lighting in place?

  Safe

  At Risk

  N/A

• 10. Do the batters appear to be stable?

  Safe

  At Risk

  N/A

24. Prevention of Dropped Objects

• Is this section relevant

• 1. Can any of the crew be struck by Dropped Objects?

  Safe

  At Risk

  N/A

• 2. Has control heirarchy i.e. 'Elimination' been considered' i.e. Removal of the hazard by performing work/task on the ground?

  Safe

  At Risk

  N/A

• 3. PRE-START Meeting - Crew Lead has discussed potential dropped object hazards resulting from, and exposure to, interfacing Contractors & workgroups.

  Safe

  At Risk

  N/A

• 4. Have risk associated with Work at Height been identified within the Pre-start (WP2)?

  Yes

  No

  N/A

• 5. Have controls for materials at height been implemented i.e. Grate/ Hand Tools, Pneumatic tools etc.

  Yes

  No

  N/A

• 6. Scaffolding; couplings/clips, tubes & planks considered and currently tagged and tested?

  Safe

  At Risk

  N/A

• 7. Has Hierarchy of control 'Substitution' - i.e. use of alternate access, substitute tools & equipment, substitute work method been considered?

  Yes

  No

  N/A

• 8. Have Engineering Controls been considered - i.e. Edge protection, catch scaffold/safety net, bins, gaps in handrails and floors covered, use of toe boards, chin straps on helmets, use of lanyards on hand tools, material and equipment to be secured whilst dismantling, lifting or moving?

  Yes

  No

  N/A

25. Hazardous Manual Tasks

• Is this section relevant?

• 1. Have risk associated with Hazardous Manual Handling tasks been discussed during the Pre-Start?

  Safe

  At Risk

  N/A

• 2. Are warm up stretches/ preparatory movements performed before starting the task?

  Safe

  At Risk

  N/A

• 3. Have identified roles and the associated TASKS been risk assessed in line with the PErforM program?

  Safe

  At Risk

  N/A

• 4. Is there adequate space i.e. free from obstacles - for the person performing the task?

  Safe

  At Risk

  N/A

• 5. Correct, PPE, tools and equipment selected for tasks being performed, i.e. use of mechanical devices if available been considered?

  Safe

  At Risk

  N/A

• 6. Have controls been implemented for all identified repetitive or sustained postures, movements or forces? i.e. rotation of personnel or use of mechanical aids?

  Safe

  At Risk

  N/A

• 7. Has the workers posture been assessed?

  Safe

  At Risk

  N/A

• 8. If exposed to vibration have controls such as 'rotation' and/ or suitability of equipment been considered?

  Safe

  At Risk

  N/A

26. Waste Management

• Is this section relevant?

• 1. Appropriate number of bins available for construction and personal waste?

  Safe

  At Risk

  N/A

• 2. Appropriate types of bin available for waste segregation (i.e. front lift, skips, paper, steel, wood, hazardous waste, aerosol cans, oily waste) -largely directed toward the depot or non mobile sites

  Safe

  At Risk

  N/A

• 3. The frequency of waste collection is sufficient for area

  Safe

  At Risk

  N/A

• 4. Bins labelled correctly (e.g. Waste Metal/Steel, Paper, Hazardous Waste)

  Safe

  At Risk

  N/A

• 5. Is liquid waste identified in bins (top loading and blue skip bins)

  Safe

  At Risk

  N/A

• 6. Paper and/or cardboard recycling bins are not contaminated with other types of waste

  Safe

  At Risk

  N/A

• 7. Bins are blocked by materials/vehicles/plant/equipment preventing the Waste Contractor removing?

  Safe

  At Risk

  N/A

• 8. Worksite or bin surrounds are clean and tidy no litter/waste on the ground

  Safe

  At Risk

  N/A

• 9. Are the bins blocking Emergency Exits?

  Safe

  At Risk

  N/A

• 10. If regulated waste is being removed from site, is a Waste tracking certificate being generated and submitted to DEHP, along with tracking in a central register?

  Safe

  At Risk

  N/A

27. Mechanical Isolations

• Is this section relevant

• 1. Has the controlling work permit and any mechanical isolation documentation been authorized by an approving authority?

  Safe

  At Risk

  N/A

• 2. Has a risk assessment been conducted to identify all potential hazardous materials and stored energy sources

  Safe

  At Risk

  N/A

• 3. Have all personnel working under the permit been appropriately trained?

  Safe

  At Risk

  N/A

• 4. Are there drawings, plans or sketches indicating the location of the Isolation points

  Safe

  At Risk

  N/A

• 5. If utilizing a lock box/ Lock board etc. has process been followed in accordance with an applicable LOTO procedure/ standard?

  Safe

  At Risk

  N/A

• 6. Have the isolation/s been effected by an Authorized Isolator and verified by a third party?

  Safe

  At Risk

  N/A

• 7. In accordance with the isolation plan are isolation points controlled as required?

  Safe

  At Risk

  N/A

• 8. Where personal locks are utilized are they affixed to the lock box or multi-hasp? And does this number align with a Sign On/Sign off Register?

  Safe

  At Risk

  N/A

• 9. Has the isolation tag been correctly filled in, Authorized and attached correctly to the isolation point?

  Safe

  At Risk

  N/A

28. Pre-Start Meeting/ Completion of Work-Pack

• Is this Section Relevant?

• 1. Have all workers onsite inclusive of any subcontractors been included in the Pre-start meeting?

  Safe

  At Risk

  N/A

• 2. Did the Pre start include all site emergency communication requirements i.e. identification of an emergency assembly point?

  Yes

  No

  N/A

• 3. Did the Pre start meeting cover the daily tasks/activities for the work group and include detail around associated risks (WP2) inclusive of step-back process if there is a change to the work scope?

  Yes

  No

  N/A

• 4. Were all onsite interactions/ interfaces i.e. Plant/ Plant, Plant/ Personnel discussed?

  Yes

  No

  N/A

• 5. Did the Pre start Meeting include discussion around being correctly warmed up i.e. stretches or pre task activities to reduce risk of injury?

  Safe

  At Risk

  N/A

• 6. Were all work-pack documents completed as required?

  Safe

  At Risk

  N/A

• 7. Are those identified for specific roles i.e. Crew Leader/ SNRP/ Standby/ Downhole etc. verified as accredited?

  Safe

  At Risk

  N/A

• 8. Have all persons onsite inclusive of subcontractors been inducted and how is this validated?

  Safe

  At Risk

  N/A

29. Supervision

• Is this section relevant?

• 1. Has the site supervisor the ability to manage and understand the scope of work for the day?

  Safe

  At Risk

  N/A

• 2. Does the site supervisor effectively interface and co-ordinate with all stakeholders?

  Safe

  At Risk

  N/A

• 3. Can the site supervisor demonstrate documented planning? E.g. WMS and use of Chemwatch - Minimum 2 week look ahead works program?

  Safe

  At Risk

  N/A

• 4. Is housekeeping and site security effectively managed?

  Safe

  At Risk

  N/A

• 5. Can the site supervisor effectively respond to site safety issues?

  Safe

  At Risk

  N/A

• 6. Does the site supervisor manage High Risk work activities?

  Yes

  No

  N/A

• 7. Has the site supervisor ensured that the work Crew have the appropriate tools and equipment to deliver the work scope without any adverse effects to quality/ safety/ environment and the community?

  Safe

  At Risk

  N/A

• 8. Does the site supervisor manage environmental activities appropriately i.e sediment fence/ CEMP/ REF?

  Yes

  No

  N/A

• Full Name

  Sign

• Full Name

  Sign