Information
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Audit #
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Inspection date
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Prepared by
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Project
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Personnel
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Site ID
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Address
1. Traffic Control
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1. Is the site a Traffic site?
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1.1 Is the Traffic Control setup in-house or external (3rd party)?
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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)
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1.1.2 Are hazard lights and beacons turned on and are traffic signs and cones set out per generic traffic plan?
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1.1.3 Is there a physical barrier/buffer (work van) between oncoming traffic and work area?
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Provide photo of traffic setup, including signage
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1.1.1 Is the Traffic Management Plan on-site and signs/cones set up correctly per plan by 3rd Party Traffic controllers?
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Provide photo of traffic setup, including signage
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Provide photo of TMP
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1.1.2 Is there a physical barrier/buffer (work van/ TC ute) between oncoming traffic and work area?
2. Personal Safety
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2.1. Is hi-vis clothing, long sleeve shirts, long pants & steel toed boots being worn by all?
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2.2. Are protective gloves being worn by all?
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2.3. Is the topside worker wearing a harness and tethered by a fall arrest when working within 2m of open MH?
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2.4. Are protective coveralls, harness, and steel-toed gumboots/waders being worn by the in-MH worker?
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2.5. Is the condition of both harnesses acceptable, and are they are within calibration/test date?
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Provide photos of calibration stickers/tags
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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)
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2.7. Which winch combination is being used?
- Static Winch + separate Self-Retracting Lanyard
- Type 3 MSA Winch (automatic)
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2.7.1. Is the winch in good operational condition and within calibration date?
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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)
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Provide photo of Ladder/Rungs or wire ladder being used
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2.7.1. Is the winch in good operational condition and within calibration date?
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2.8 What is the teams emergency exit plan if the primary winch fails?
- 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
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2.9. Is the Oxybox being worn or readily available top-side to the in-MH worker, and within calibration/test date?
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2.10. Are ear muffs or ear plugs available and being worn when drilling antenna hole?
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2.11. Are mobile phones on and easily accessible?
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2.12. Is sunscreen and insect repellant available?
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2.13. Are safety glasses or face shield being worn by in-manhole worker?
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2.14. Is water, soap, hand sanitiser and paper towel available?
3. Gas Meters
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3.1. Has the gas meter been response (bump) tested?
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3.2. Is the gas meter within test/calibration date?
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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?
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3.4. Has the atmosphere in the manhole been tested and is it safe for a confined space entry?
4. Equipment
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4.1. Are tools clean and stored appropriately in their respective buckets?
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4.2. Is the drill operational and properly maintained?
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4.3 Is all 240V electrical equipment inspected and tagged?
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4.3 Is the velocity meter operational, within calibration date and stored in a separate compartment of tool-bucket?
5. Operational
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5.1. Is the work site clean and tidy and free of trip hazards?
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5.2. Are ropes attached to chokers and being used appropriately for lowering the gas meter and tool buckets
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5.3. Is the monitor at least 1 meter away from the manhole or securely fixed to the tripod leg with strap?
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5.4. Is the work area barricaded off safely with "Confined Space" signs placed to warn public?
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Provide photo of CSE sign and barricades
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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.)
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5.6. Are the sensor cables secured neatly and not hanging in flow, including when monitor is stored in manhole?
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5.7 Is the topside worker in continuous verbal/visual contact with the in-MH worker?
6. Paperwork
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6.1. Has the confined space entry permit been completed, and has the relevant control room been notified (if required)?
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6.2. Has the risk assessment (HIDRA) been reviewed and updated to include all relevant Hazards and signed off by all people onsite?
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6.3. Is there a current and approved Project Management Plan (PMP) onsite?
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6.5 Are the project specific SWMS on site and have all crew reviewed and signed off on them?
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Provide photo of SWMS sign-off page
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6.6. Has the site visit log been updated?
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6.7. Has the daily entry been completed for the site?
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Has the driver(s) been identified on the Daily?
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 Are all people on site trained in performing First-Aid & CPR?
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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Provide photo of cargo compartment of van
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8.3. Is the vehicle within its service date?
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8.4 Is the driver of the vehicle for the day clearly identified on the Daily Form?
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8.5. Is there a fire extinguisher available and is it within the 6 month service date?
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8.6. Does the vehicle have a correctly stocked first aid kit? (check for sufficient stock levels of Saline eye wash)
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8.7. Are the location of the fire extinguisher and first aid kit known to staff & easily accessible in van?
10. Rescue Simulation Exercise
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10.1 Was the rescue simulation completed under 2 minutes, and the in-manhole worker retrieved without them assisting/climbing out?
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10.1.1 What equipment or process restricted or hindered the rescue procedure?
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10.2. How deep is the manhole?
12. MSDS
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12.1. Is the "Field Resources (ipad)" folder sync'd or quickly accessible on the ipad?
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12.2. Is the location of the SDS's known by all crew?
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12.3. Has everyone been trained on these SDS'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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What is the name of the nearest hospital/emergency department?
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Are at least 2 members of the crew licensed and trained in driving the van?
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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?
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13.3 Are St John Fact sheets on site and do all crew members know the location of this sheet?
14. Environmental
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14.1 Has any sewage spilled outside manhole? (including transfer from equipment or worker exiting manhole)
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14.1.1. Has the spilled be cleaned up? (shoveling it back into manhole and/or cleaning with disinfectant spray using high pressure washer)
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14.2 Was a significant amount of vegetation impacted/removed to access site?
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14.2.1 What measures were taken to minimize the environmental impact?
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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)
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14.3.1 What environmental risks should have been updated onto the HIDRA? Add them to HIDRA now.
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14.4 Is any noisy equipment being used that may cause disturbance to nearby residents? (i.e drill, generator)
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14.4.1 Is the work occurring between 7am-6pm?
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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?
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Provide evidence (copy of letter, email or text message notification)
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14.5 If manhole was sealed prior to opening has it been resealed to prevent odours escaping?
Crew Assessment
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Name of In-manhole worker: (wearing overalls, harness, helmet, gloves, safety glasses, gumboots/waders)
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Competency Rating: C =Competent , R = Retrain
- Competent
- Retrain
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Retraining Details:
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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)
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Competency Rating: C =Competent , R = Retrain
- Competent
- Retrain
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Retraining Details:
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Name of Third-person (rescuer & data entry): (carrying mobile phone, completes CSE form, competent in Qstart)
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Competency Rating: C =Competent , R = Retrain
- Competent
- Retrain
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Retraining Details:
If conducting a remote (telephone) audit- upload photos of site inspection here:
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Photo of site (including barricades, signage, Tripod setup, Topside worker attached to harness)
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Photo of in-manhole worker geared up for entry
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Photo of Gas meter calibration sticker
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Photo of Tripod inspection sticker
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Photo of Winch/RPD inspection sticker
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Photo of Harness inspection sticker
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Photo of traffic signage (if applicable)
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Photo of Traffic management plan (if applicable)
If conducting a remote (telephone) audit- upload photos of documentation here:
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Photo of completed SWMS sign-off page for relevant Project
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Photo of completed HIDRA for relevant site
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Photo of completed Confined Space Permit for relevant site
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Photo of completed Site Visit Log for relevant site
Corrective Actions and Sign Off
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Enter any corrective actions that will be undertaken
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On site representative
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Auditor's signature