Internal Field Safety Audit (ADS) - Revised 08/18

• Audit #

• Inspection date

  Date

• Prepared by

• Project

• Personnel

• Site ID

• Address
  Address

1. Traffic Control

• 1. Is the site a Traffic site?

  Yes

  No

  N/A

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

  N/A

  In-house

  External/3rd party

• Provide photo of documentation listing site as in-house

  Media

• 1.1.1. Is the Field Specialist correctly certified for Traffic Control work?

  Yes

  No

  N/A

• Provide photo of traffic control cards

  Media

• 1.1.2. Are Stop/Slow bats and hazard lights/beacons being used correctly, if required?

  Yes

  No

  N/A

• Provide photo of stop/slow bat & hazard lights in use

  Media

• 1.2. Is the Traffic Management Plan (TMP) on-site and effective?

  Yes

  No

  N/A

• Provide photo of site with traffic management implemented

  Media

• 1.3. Is the site setup in accordance with the TMP?

  Yes

  No

  N/A

• Provide photo of site setup

  Media

2. Personal Safety

• 2.1. Is hi-vis clothing being worn by all?

  Yes

  No

  N/A

• Provide photo of personnel wearing hi-vis clothing

  Media

• 2.2. Are protective pants and long-sleeves being worn by all?

  Yes

  No

  N/A

• Provide photo of personnel wearing pants and long-sleeves

  Media

• 2.3. Are protective waders being worn by the in-MH worker?

  Yes

  No

  N/A

• Provide photo of in-MH worker wearing waders

  Media

• 2.4. Are protective gloves being worn by all?

  Yes

  No

  N/A

• Provide photos of protective gloves in use

  Media

• 2.5. Are steel-capped boots worn by all?

  Yes

  No

  N/A

• Provide photo of steel-capped boots in use

  Media

• 2.6. Are hard hats being used appropriately?

  Yes

  No

  N/A

• Provide photo of hard hats in use

  Media

• 2.7. Is the condition of both topside & in-MH harnesses acceptable, and are they are within calibration/test date?

  Yes

  No

  N/A

• Provide photo of topside harness, including test tag

  Media

• Provide photo of in-MH harness, including test tag

  Media

• 2.8. Is the condition of the RPD/winch acceptable, and is it within calibration/test date?

  Yes

  No

  N/A

• Provide photo of RPD/winch, including test tag

  Media

• 2.9. Is the topside worker wearing a harness and tethered by a fall arrest, and are both within calibration/test date?

  Yes

  No

  N/A

• Provide photo of topside worker wearing harness & fall arrest

  Media

• Provide photo of topside fall arrest test tag

  Media

• 2.10. Is the Oxybok available to the in-MH worker, and within calibration/test date?

  Yes

  No

  N/A

• Provide photo of OXybok, including test tag

  Media

• 2.11. Are ear muffs or ear plugs available?

  Yes

  No

  N/A

• Provide photo of ear muffs & ear plugs

  Media

• 2.12. Is the nearest hospital known by crew?

  Yes

  No

  N/A

• Provide photo of nearest hospital documented on form

  Media

• 2.13. Are mobile phones on and easily accessible?

  Yes

  No

  N/A

• Provide photo of standby personnel's mobile phone

  Media

• 2.14. Has the "lone worker policy" been followed, if applicable?

  Yes

  No

  N/A

• Provide documentation of lone worker arrangements with supervisor

  Media

• 2.15. Is sunscreen and insect repellant available?

  Yes

  No

  N/A

• Provide photo of sunscreen & insect repellant

  Media

• 2.16. Are safety glasses available?

  Yes

  No

  N/A

• Provide photo of safety glasses

  Media

• 2.17. Is water, hand cleaner and paper towel available?

  Yes

  No

  N/A

• Provide photo of water, hand cleaner & paper towel

  Media

3. Gas Meters

• 3.1. Has the gas meter been response test & results recorded?

  Yes

  No

  N/A

• Provide photo of gas meter bump test form & results

  Media

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

  Yes

  No

  N/A

• Provide photo of gas meter test tag

  Media

• 3.3. Has the atmosphere in the manhole been gas tested?

  Yes

  No

  N/A

• Provide photo of gas results page of CSE

  Media

• 3.4. Was the area around the manhole tested for gases and checked for hazards?

  Yes

  No

  N/A

• Provide photo of gas meter testing area around MH

  Media

4. Equipment

• 4.1. Is the tripod correctly installed?

  Yes

  No

  N/A

• Provide photo of set up tripod

  Media

• 4.2. Is the tool bucket and rope being used appropriately?

  Yes

  No

  N/A

• Provide photo of tool bucket & rope in use

  Media

• 4.3. Is all equipment stored correctly?

  Yes

  No

  N/A

• Provide photo of equipment in van

  Media

• 4.4. Are tools clean and stored appropriately?

  Yes

  No

  N/A

• Provide photo of tools

  Media

• 4.5. Is the drill operational and properly maintained?

  Yes

  No

  N/A

• Provide photo of drill

  Media

• 4.6. Is all other equipment within calibration or service check interval?

  Yes

  No

  N/A

• Provide photo of calibration/service tags

  Media

• 4.7. Is all electrical equipment inspected and tagged, if required?

  Yes

  No

  N/A

• Provide photo of electrical equipment tags

  Media

5. Operation

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

  Yes

  No

  N/A

• 5.2. Is the work site clean and tidy?

  Yes

  No

  N/A

• Provide photo of work site

  Media

• 5.3. Is all equipment topside secure from falling into manhole?

  Yes

  No

  N/A

• Provide photo of topside equipment

  Media

• 5.4. Is the work area fenced off safely?

  Yes

  No

  N/A

• Provide photo of work area

  Media

• 5.5. Are the appropriate "confined space" signs placed out to warn the public?

  Yes

  No

  N/A

• Provide photo of confined space signs

  Media

• 5.6. Does the velocity meter within calibration date?

  Yes

  No

  N/A

• Provide photo of velocity meter calibration date

  Media

6. Paperwork

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

  Yes

  No

  N/A

• Provide photo of CSE permit

  Media

• Provide photo of call-in or email notification as appropriate

  Media

• 6.2. Has a site-specific risk assessment been reviewed with co-workers?

  Yes

  No

  N/A

• Provide photo of reviewed risk assessment

  Media

• 6.3. Has the risk assessment been signed off by all people onsite?

  Yes

  No

  N/A

• Provide photo of risk assessment sign off

  Media

• 6.4. If appropriate, has the risk assessment been updated?

  Yes

  No

  N/A

• Provide photo of risk assessment

  Media

• 6.5. Is the risk assessment appropriate for the site?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Provide photo of PMP

  Media

• 6.7. Has the site visit log been updated?

  Yes

  No

  N/A

• Provide photo of site visit log

  Media

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

  Yes

  No

  N/A

• Provide photo of daily entry

  Media

• 6.9. Are all forms fully completed?

  Yes

  No

  N/A

• Provide photo of forms

  Media

7. Certification

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

  Yes

  No

  N/A

• Provide photos of ALL CSE tickets

  Media

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

  Yes

  No

  N/A

• Provide photo of OHS white cards

  Media

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

  Yes

  No

  N/A

• Provide photo of client induction cards

  Media

• 7.4. Do all people have ADS ID cards?

  Yes

  No

  N/A

• Provide photo of ADS ID cards

  Media

8. Vehicle

• 8.1. Is the vehicle registration current?

  Yes

  No

  N/A

• Provide photo of license plate

  Media

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

  Yes

  No

  N/A

• Provide photo of inside of vehicle

  Media

• 8.3. Is the vehicle within its service date?

  Yes

  No

  N/A

• Provide photo of service sticker

  Media

• Provide photo of odometer

  Media

• 8.4. Is the vehicle logbook up to date?

  Yes

  No

  N/A

• Provide photo of vehicle logbook

  Media

• 8.5. Is there a fire extinguisher available and is it within it's service date?

  Yes

  No

  N/A

• Provide photo of fire extinguisher & service date

  Media

• 8.6. Does the vehicle have a correctly stocked first aid kit?

  Yes

  No

  N/A

• Provide photo of first aid kit

  Media

• 8.7. Are the location of the fire extinguisher and first aid kit known to staff?

  Yes

  No

  N/A

9. Monitoring Point

• 9.1. Are the site conditions safe?

  Yes

  No

  N/A

• Provide photo of site conditions

  Media

• 9.2. Are the sensor cables secured neatly?

  Yes

  No

  N/A

• Provide photo of sensor cables secured

  Media

• 9.3. Are the flow hydraulics safe for entry?

  Yes

  No

  N/A

• Provide photo of site flow hydraulics

  Media

10. Rescue Simulation Exercise

• 10.1 Was the rescue simulation carried out effectively?

  Yes

  No

  N/A

• 10.2. How deep was the MH?

• 10.3. How fast was the rescue simulation?

11. Safe Work Method Statements

• 11.1. Are the relevant SWMS onsite?

  Yes

  No

  N/A

• Provide photo of SWMS

  Media

• 11.2. Were the SWMS reviewed and followed?

  Yes

  No

  N/A

• Provide photo of SWMS sign off

  Media

12. MSDS

• 12.1. Are all relevant MSDS's onsite?

  Yes

  No

  N/A

• Provide photo of MSDS directory

  Media

• 12.2. Has everyone been trained on these MSDS's?

  Yes

  No

  N/A

13. Emergency Response

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

  Yes

  No

  N/A

• Provide photo of Emergency Response Procedure for site

  Media

• 13.2 Are all field personnel onsite familiar with the location of the St Johns First Aid Fact Sheets for quick reference?

  Yes

  No

  N/A

• Provide photo of St John First Aid Fact Sheet directory

  Media

Crew Assessment

• Crew Member:

• Role:

• Competency Rating: C =Competent , R = Retrain

  Select Competent Retrain

  • Competent
  • Retrain

• Retraining Details:

• Crew Member:

• Role:

• Competency Rating: C =Competent , R = Retrain

  Select Competent Retrain

  • Competent
  • Retrain

• Retraining Details:

• Crew Member:

• Role:

• Competency Rating: C =Competent , R = Retrain

  Select Competent Retrain

  • Competent
  • Retrain

• Retraining Details:

Corrective Actions

• Enter any corrective actions that will be undertaken

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign