Information
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Personnel
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Inspection date
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Prepared by
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Site ID
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Address
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Audit #
1. Traffic Control
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1.1. Is the Traffic Management Plan (TMP) on-site and effective?
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1.2. Is the site setup in accordance with the TMP?
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1.3. Are Stop/Slow bats and hazard lights/beacons being used correctly, if required?
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1.4. Is the Field Specialist correctly certified for Traffic Control work?
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1.5. Is the Traffic Control setup in-house or external (3rd party)?
2. Personal Safety
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2.1. Is hi-viz clothing being worn by all?
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2.2. Are protective pants and jackets being worn by all?
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2.3. Are protective waders being worn by the in-MH worker?
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2.4. Are protective gloves being worn by all?
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2.5. Are steel-capped boots worn by all?
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2.6. Are hard hats being used appropriately?
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2.7. Is the condition of the harnesses acceptable?
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2.8. Is the condition of the RPD/winch acceptable?
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2.9. Is the topside worker wearing a harness and tethered by a fall arrest?
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2.10. Is the oxybox available?
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2.11. Are ear muffs or ear plugs available?
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2.12. Is the nearest hospital known by crew?
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2.13. Are mobile phones on and easily accessible?
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2.14. Has the "lone worker policy" been followed, if applicable?
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2.15. Is sunscreen and insect repellant available?
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2.16. Are safety glasses available?
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2.17. Is water, hand cleaner and paper towel available?
3. Gas Meters
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3.1. Is the gas meter response test recorded?
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3.2. Is the gas meter within the 6 month test period?
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3.3. Has the manhole been checked?
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3.4. Was the area around the manhole tested for gases and checked for hazards?
4. Equipment
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4.1. Is the tripod correctly installed?
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4.2. Is the tool bucket and rope being used appropriately?
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4.3. Is all equipment stored correctly?
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4.4. Are tools clean and stored appropriately?
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4.5. Is the drill operational and properly maintained?
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4.6. Is all equipment within calibration or service check interval?
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4.7. Is all electrical equipment inspected and tagged, if required?
5. Operation
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5.1. Is the topside worker in verbal/visual contact with the in-MH worker?
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5.2. Is the work site clean and tidy?
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5.3. Is all equipment topside secure from falling into manhole?
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5.4. Is the work area fenced off safely?
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5.5. Are the appropriate "confined space" signs placed out to warn the public?
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5.6. Does the pygmy/prop have a current certificate?
6. Paperwork
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6.1. Has the confined space entry permit been completed, and has the relevant control room been called into (if required)?
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6.2. Has a site-specific risk assessment been reviewed with co-workers?
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6.3. Has the risk assessment been signed off by all people onsite?
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6.4. Has the risk assessment been updated?
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6.5. Is the risk assessment appropriate for the site?
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6.6. Is there a current and approved Project Management Plan (PMP) onsite?
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6.7. Has the site visit log been updated?
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6.8. Has the daily been completed?
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6.9. Is all "paperwork" logical and legible?
7. Certification
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7.1. Do all people on site have a valid confined space entry ticket?
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7.2. Do all people onsite have a valid OHS white card?
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7.3. Do all people onsite have valid relevant client inductions (if required)?
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7.4. Do all people have ADS ID cards?
8. Vehicle
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8.1. Is the vehicle registration current?
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8.2. Is the vehicle clean, tidy and organised?
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8.3. Is the vehicle within its service date?
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8.4. Is the vehicle logbook up to date?
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8.5. Is there a fire extinguisher available and is it within it's service date?
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8.6. Does the vehicle have a correctly stocked first aid kit?
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8.7. Are the location of the fire extinguisher and first aid kit known to staff?
9. Monitoring Point
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9.1. Are the site conditions safe?
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9.2. Are the sensor cables secured neatly?
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9.3. Are the flow hydraulics safe for entry?
10. Rescue Simulation Exercise
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10.1 Was the rescue simulation carried out effectively?
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10.2. How deep was the MH?
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10.3. How fast was the rescue simulation?
11. Safe Work Method Statements
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11.1. Are the relevant SWMS onsite?
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11.2. Were the SWMS reviewed and followed?
12. MSDS
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12.1. Are all relevant MSDS's onsite?
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12.2. Has everyone been trained on these MSDS's?
13. Emergency Response
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13.1 Are all field personnel onsite familiar with the Emergency Response Procedure applicable to that site?
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13.2 Are the St John First Aid Fact Sheets on site?
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13.3 Are all field personnel onsite familiar with the location of the St Johns First Aid Fact Sheets for quick reference?
Crew Assessment
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Crew Member:
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Role:
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Competency Rating: C =Competent , R = Retrain
- Competent
- Retrain
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Retraining Details:
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Crew Member:
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Role:
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Competency Rating: C =Competent , R = Retrain
- Competent
- Retrain
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Retraining Details:
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Crew Member:
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Role:
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Competency Rating: C =Competent , R = Retrain
- Competent
- Retrain
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Retraining Details:
Corrective Actions
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Enter any corrective actions that will be undertaken
Sign Off
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On site representative
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Auditor's signature