Internal Field Safety Audit (ADS) - Revised 11/22

• 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 for Traffic Control work?

  Yes

  No

• 1.1.2 Are Stop/Slow bats, hazard lights and beacons, traffic signs and cones being used correctly?

  Yes

  No

• Provide photo of traffic setup, including signage

  Media

• 1.1.1 Is the Traffic Management Plan (TMP) on-site and being used effectively by 3rd Party Traffic controllers?

  Yes

  No

• Provide photo of traffic setup, including signage

  Media

• Provide photo of TMP

  Media

2. Personal Safety

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

  Yes

  No

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

  Yes

  No

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

  Yes

  No

• 2.4. Are protective gloves being worn by all?

  Yes

  No

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

  Yes

  No

• 2.6. Is the in-manhole worker wearing a hardhat?

  Yes

  No

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

  Yes

  No

• 2.8. Is the static winch being used together with an in-manhole self-retracting lanyard (SRL) and are both in good condition and within calibration/test date? (only exemption is when using type 3 MSA Winch or RPD with ladder rungs)

  Yes

  No

• Provide photo of tripod setup including Winch and SRL

  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

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

  Yes

  No

• 2.11. Are ear muffs or ear plugs available?

  Yes

  No

• 2.12. Are mobile phones on and easily accessible?

  Yes

  No

• 2.13. Is sunscreen and insect repellant available?

  Yes

  No

• 2.14. Are safety glasses available?

  Yes

  No

• 2.15. Is water, hand cleaner 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

• Provide photo of gas meter test tag

  Media

• 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

• Provide photo of gas meter secured to rope

  Media

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

  Yes

  No

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

  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

  N/A

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

• Provide photo of monitor and its proximity to the manhole

  Media

• 5.4. Is the work area barricaded off safely?

  Yes

  No

• Provide photo of work area

  Media

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

  Yes

  No

• 5.6. Are the site conditions safe for a confined space entry? (consider atmospheric testing, hydraulic conditions/ flow depth, visual and verbal contact can be maintained with in-manhole worker.)

  Yes

  No

• 5.6.1 DO NOT PERFORM Confined Space Entry. List what site conditions are unsafe for confined space entry.

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

  Yes

  No

• 5.8 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 signed off by all people onsite?

  Yes

  No

• 6.3. Discuss with crew, are there any additional risks at site that have NOT YET been recorded on the HIDRA?

  Select No additional risks identified Additional risks identified and not yet recorded

  • No additional risks identified
  • Additional risks identified and not yet recorded

• What additional risks did the crew identify? Update the HIDRA to include these now

• 6.4. 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. Do all people have ADS ID cards?

  Yes

  No

• 7.5 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

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

  Yes

  No

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

  Yes

  No

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

  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?

• 10.3. How fast was the rescue simulation?

12. MSDS

• 12.1. Are all relevant SDS's onsite?

  Yes

  No

• 12.2. 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 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)

  No

  Yes

• 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 any 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, Oxybok - if applicable)

• 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