Internal Field Safety Audit (ADS) - Revised 03/24

• Audit #

• Inspection date

  Date

• Prepared by

• Project

• Personnel

• Site ID

• Address

1. Traffic Control

• 1. Is the site a Traffic site?

  Traffic site

  Non-Traffic site

• 1.1 Is the Traffic Control setup in-house or external (3rd party)?

  In-house

  External/3rd party

• 1.1.1 Is the Field Specialist correctly certified to perform Internal Traffic Control work?<br> (ie placement of workman signs, speed limit reductions -VIC only, no Stop-Slow)

  Yes

  No

• 1.1.2 Are hazard lights and beacons turned on and are traffic signs and cones set out per generic traffic plan?

  Yes

  No

• 1.1.3 Is there a physical barrier/buffer (work van) between oncoming traffic and work area?

  Yes

  No

• Provide photo of traffic setup, including signage

  Media

• 1.1.1 Is the Traffic Management Plan on-site and signs/cones set up correctly per plan by 3rd Party Traffic controllers?

  Yes

  No

• Provide photo of traffic setup, including signage

  Media

• Provide photo of TMP

  Media

• 1.1.2 Is there a physical barrier/buffer (work van/ TC ute) between oncoming traffic and work area?

  Yes

  No

2. Personal Safety

• 2.1. Is hi-vis clothing, long sleeve shirts, long pants & steel toed boots being worn by all?

  Yes

  No

• 2.2. Are protective gloves being worn by all?

  Yes

  No

• 2.3. Is the topside worker wearing a harness and tethered by a fall arrest when working within 2m of open MH?

  Yes

  No

• 2.4. Are protective coveralls, harness, and steel-toed gumboots/waders being worn by the in-MH worker?

  Yes

  No

• 2.5. Is the condition of both harnesses acceptable, and are they are within calibration/test date?

  Yes

  No

• Provide photos of calibration stickers/tags

  Media

• 2.6. Is the in-manhole worker wearing a hardhat, is it in good condition & within 3-years of manufacture date? (check month/year stamped inside helmet)

  Yes

  No

• 2.7. Which winch combination is being used?

  Select Static Winch + separate Self-Retracting Lanyard Type 3 MSA Winch (automatic)

  • Static Winch + separate Self-Retracting Lanyard
  • Type 3 MSA Winch (automatic)

• 2.7.1. Is the winch in good operational condition and within calibration date?

  Yes

  No

• 2.7.2. Are either the ladder/rungs or wire ladder being used by F.S to access bottom of MH? <br>(Type 3 auto winch NOT to be used to lower/raise worker into MH - except for drill or emergency evacuations)

  Yes

  No

• Provide photo of Ladder/Rungs or wire ladder being used

  Media

• 2.7.1. Is the winch in good operational condition and within calibration date?

  No

  Yes

• 2.8 What is the teams emergency exit plan if the primary winch fails?

  Select 1) Climb out using ladder/rungs (must be in good condition) 2) Set up wire ladder & climb out (wire ladder must be available) 3) Set up spare winch for retrieval (spare winch must be available) 4) 30m SRL has built in retrieval handle 5) None of the above

  • 1) Climb out using ladder/rungs (must be in good condition)
  • 2) Set up wire ladder & climb out (wire ladder must be available)
  • 3) Set up spare winch for retrieval (spare winch must be available)
  • 4) 30m SRL has built in retrieval handle
  • 5) None of the above

• 2.9. Is the Oxybox being worn or readily available top-side to the in-MH worker, and within calibration/test date?

  Yes

  No

• 2.10. Are ear muffs or ear plugs available and being worn when drilling antenna hole?

  Yes

  No

• 2.11. Are mobile phones on and easily accessible?

  Yes

  No

• 2.12. Is sunscreen and insect repellant available?

  Yes

  No

• 2.13. Are safety glasses or face shield being worn by in-manhole worker?

  Yes

  No

• 2.14. Is water, soap, hand sanitiser and paper towel available?

  Yes

  No

3. Gas Meters

• 3.1. Has the gas meter been response (bump) tested?

  Yes

  No

• 3.2. Is the gas meter within test/calibration date?

  Yes

  No

• 3.3. Is the gas meter secured to the rope with 2 separate attachment points, and has the tail end of the rope been tied off to tripod leg?

  Yes

  No

• 3.4. Has the atmosphere in the manhole been tested and is it safe for a confined space entry?

  Yes

  No

4. Equipment

• 4.1. Are tools clean and stored appropriately in their respective buckets?

  Yes

  No

• 4.2. Is the drill operational and properly maintained?

  Yes

  No

  N/A

• 4.3 Is all 240V electrical equipment inspected and tagged?

  Yes

  No

  N/A

• 4.3 Is the velocity meter operational, within calibration date and stored in a separate compartment of tool-bucket?

  Yes

  No

5. Operational

• 5.1. Is the work site clean and tidy and free of trip hazards?

  Yes

  No

• 5.2. Are ropes attached to chokers and being used appropriately for lowering the gas meter and tool buckets

  Yes

  No

• 5.3. Is the monitor at least 1 meter away from the manhole or securely fixed to the tripod leg with strap?

  Yes

  No

• 5.4. Is the work area barricaded off safely with "Confined Space" signs placed to warn public?

  Yes

  No

• Provide photo of CSE sign and barricades

  Media

• 5.5. Have all Hazards been identified and appropriate controls implemented to continue with work? <br>(consider hydraulic conditions/ flow depth, visual and verbal contact being maintained, traffic volumes, ventilation requirements etc.)

  Yes

  No

• 5.6. Are the sensor cables secured neatly and not hanging in flow, including when monitor is stored in manhole?

  Yes

  No

• 5.7 Is the topside worker in continuous verbal/visual contact with the in-MH worker?

  Yes

  No

6. Paperwork

• 6.1. Has the confined space entry permit been completed, and has the relevant control room been notified (if required)?

  Yes

  No

• 6.2. Has the risk assessment (HIDRA) been reviewed and updated to include all relevant Hazards and signed off by all people onsite?

  Yes

  No

• 6.3. Is there a current and approved Project Management Plan (PMP) onsite?

  Yes

  No

• 6.5 Are the project specific SWMS on site and have all crew reviewed and signed off on them?

  Yes

  No

• Provide photo of SWMS sign-off page

  Media

• 6.6. Has the site visit log been updated?

  Yes

  No

• 6.7. Has the daily entry been completed for the site?

  Yes

  No

• Has the driver(s) been identified on the Daily?

  No

  Yes

7. Certification

• 7.1. Do all people on site have a valid confined space entry ticket?

  Yes

  No

• 7.2. Do all people onsite have a valid OHS white card?

  Yes

  No

• 7.3. Do all people onsite have valid relevant client inductions (if required)?

  Yes

  No

• 7.4 Are all people on site trained in performing First-Aid & CPR?

  Yes

  No

8. Vehicle

• 8.1. Is the vehicle registration current?

  Yes

  No

• 8.2. Is the vehicle clean, tidy and organised?

  Yes

  No

• Provide photo of cargo compartment of van

  Media

• 8.3. Is the vehicle within its service date?

  Yes

  No

• 8.4 Is the driver of the vehicle for the day clearly identified on the Daily Form?

  Yes

  No

• 8.5. Is there a fire extinguisher available and is it within the 6 month service date?

  Yes

  No

• 8.6. Does the vehicle have a correctly stocked first aid kit? (check for sufficient stock levels of Saline eye wash)

  Yes

  No

• 8.7. Are the location of the fire extinguisher and first aid kit known to staff & easily accessible in van?

  Yes

  No

10. Rescue Simulation Exercise

• 10.1 Was the rescue simulation completed under 2 minutes, and the in-manhole worker retrieved without them assisting/climbing out?

  Yes

  No

• 10.1.1 What equipment or process restricted or hindered the rescue procedure?

• 10.2. How deep is the manhole?

12. MSDS

• 12.1. Is the "Field Resources (ipad)" folder sync'd or quickly accessible on the ipad?

  Yes

  No

• 12.2. Is the location of the SDS's known by all crew?

  Yes

  No

• 12.3. Has everyone been trained on these SDS's?

  Yes

  No

13. Emergency Response

• 13.1 Are all field personnel onsite familiar with the Emergency Response Procedure applicable to that site?

  Yes

  No

• What is the name of the nearest hospital/emergency department?

• Are at least 2 members of the crew licensed and trained in driving the van?

  Yes

  No

• 13.2 What is the emergency exit plan if the primary winch was to fail and they had to retrieve worker from bottom of MH?

• 13.3 Are St John Fact sheets on site and do all crew members know the location of this sheet?

  Yes

  No

14. Environmental

• 14.1 Has any sewage spilled outside manhole? (including transfer from equipment or worker exiting manhole)

  Yes

  No

• 14.1.1. Has the spilled be cleaned up? (shoveling it back into manhole and/or cleaning with disinfectant spray using high pressure washer)

  Yes

  No

• 14.2 Was a significant amount of vegetation impacted/removed to access site?

  Yes

  No

• 14.2.1 What measures were taken to minimize the environmental impact?

• 14.3 Has risk assessment been conducted with regard to the impact on environment? (i.e if any vegetation was removed or any sewerage spill/overflows have occurred, has the HIDRA been updated)

  Yes

  No

• 14.3.1 What environmental risks should have been updated onto the HIDRA? Add them to HIDRA now.

• 14.4 Is any noisy equipment being used that may cause disturbance to nearby residents? (i.e drill, generator)

  No

  Yes, generator/drill is needed

• 14.4.1 Is the work occurring between 7am-6pm?

  Yes

  No

• 14.4.1.1 Has the Field Specialist/ Regional Manager/ Client notified nearby residents of night works and the need to use generator/drill after hours?

  Yes

  No

• Provide evidence (copy of letter, email or text message notification)

  Media

• 14.5 If manhole was sealed prior to opening has it been resealed to prevent odours escaping?

  Yes

  No

  N/A

Crew Assessment

• Name of In-manhole worker: (wearing overalls, harness, helmet, gloves, safety glasses, gumboots/waders)

• Competency Rating: C =Competent , R = Retrain

  Select Competent Retrain

  • Competent
  • Retrain

• Retraining Details:

• Name of Topside worker: (wearing harness attached to lanyard, gloves, carrying mobile phone, confirms gas results prior to entry, maintains visual and verbal contact with in-manhole worker)

• Competency Rating: C =Competent , R = Retrain

  Select Competent Retrain

  • Competent
  • Retrain

• Retraining Details:

• Name of Third-person (rescuer & data entry): (carrying mobile phone, completes CSE form, competent in Qstart)

• Competency Rating: C =Competent , R = Retrain

  Select Competent Retrain

  • Competent
  • Retrain

• Retraining Details:

If conducting a remote (telephone) audit- upload photos of site inspection here:

• Photo of site (including barricades, signage, Tripod setup, Topside worker attached to harness)

  Media

• Photo of in-manhole worker geared up for entry

  Media

• Photo of Gas meter calibration sticker

  Media

• Photo of Tripod inspection sticker

  Media

• Photo of Winch/RPD inspection sticker

  Media

• Photo of Harness inspection sticker

  Media

• Photo of traffic signage (if applicable)

  Media

• Photo of Traffic management plan (if applicable)

  Media

If conducting a remote (telephone) audit- upload photos of documentation here:

• Photo of completed SWMS sign-off page for relevant Project

  Media

• Photo of completed HIDRA for relevant site

  Media

• Photo of completed Confined Space Permit for relevant site

  Media

• Photo of completed Site Visit Log for relevant site

  Media

Corrective Actions and Sign Off

• Enter any corrective actions that will be undertaken

• On site representative

  Sign

• Auditor's signature

  Sign