Information
-
Audit #
-
Inspection date
-
Prepared by
-
Project
-
Personnel
-
Site ID
-
Address
1. Traffic Control
-
1. Is the site a Traffic site?
-
1.1 Is the Traffic Control setup in-house or external (3rd party)?
-
1.1.1 Is the Field Specialist correctly certified for Traffic Control work?
-
1.1.2 Are Stop/Slow bats, hazard lights and beacons, traffic signs and cones being used correctly?
-
Provide photo of traffic setup, including signage
-
1.1.1 Is the Traffic Management Plan (TMP) on-site and being used effectively by 3rd Party Traffic controllers?
-
Provide photo of traffic setup, including signage
-
Provide photo of TMP
2. Personal Safety
-
2.1. Is hi-vis clothing being worn by all?
-
2.2. Are protective pants and long-sleeves being worn by all?
-
2.3. Are protective overalls being worn by the in-MH worker?
-
2.4. Are protective gloves being worn by all?
-
2.5. Are steel-capped boots worn by all?
-
2.6. Is the in-manhole worker wearing a hardhat?
-
2.7. Is the condition of both topside & in-MH harnesses acceptable, and are they are within calibration/test date?
-
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)
-
Provide photo of tripod setup including Winch and SRL
-
2.9. Is the topside worker wearing a harness and tethered by a fall arrest, and are both within calibration/test date?
-
2.10. Is the Oxybok available to the in-MH worker, and within calibration/test date?
-
2.11. Are ear muffs or ear plugs available?
-
2.12. Are mobile phones on and easily accessible?
-
2.13. Is sunscreen and insect repellant available?
-
2.14. Are safety glasses available?
-
2.15. Is water, hand cleaner and paper towel available?
-
Provide photo water container, soap etc.
3. Gas Meters
-
3.1. Has the gas meter been response (bump) tested?
-
3.2. Is the gas meter within test/calibration date?
-
Provide photo of gas meter test tag
-
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?
-
Provide photo of gas meter secured to rope
-
3.4. Was the area around the manhole tested for gases and checked for hazards?
-
3.5. Has the atmosphere in the manhole been gas tested?
4. Equipment
-
4.1. Are tools clean and stored appropriately in their respective buckets?
-
4.2. Is the drill operational and properly maintained?
-
4.3 Is all 240V electrical equipment inspected and tagged?
-
4.3 Is the velocity meter operational and within calibration date?
5. Operational
-
5.1. Is the work site clean and tidy and free of trip hazards?
-
5.2. Are ropes attached to chokers and being used appropriately for lowering the gas meter and tool buckets
-
5.3. Is the monitor AT LEAST 1 meter away from the manhole or securely fixed to the tripod leg so it can't fall into the manhole?
-
Provide photo of monitor and its proximity to the manhole
-
5.4. Is the work area barricaded off safely?
-
Provide photo of work area
-
5.5. Are the appropriate "confined space" signs placed out to warn the public?
-
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.)
-
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?
-
5.8 Is the topside worker in continuous verbal/visual contact with the in-MH worker?
6. Paperwork
-
6.1. Has the confined space entry permit been completed, and has the relevant control room been notified (if required)?
-
6.2. Has the risk assessment (HIDRA) been reviewed and signed off by all people onsite?
-
6.3. Discuss with crew, are there any additional risks at site that have NOT YET been recorded on the HIDRA?
- 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?
-
6.5 Are the project specific SWMS on site and have all crew reviewed and signed off on them?
-
Provide photo of SWMS sign-off page
-
6.6. Has the site visit log been updated?
-
6.7. Has the daily entry been completed for the site?
7. Certification
-
7.1. Do all people on site have a valid confined space entry ticket?
-
7.2. Do all people onsite have a valid OHS white card?
-
7.3. Do all people onsite have valid relevant client inductions (if required)?
-
7.4. Do all people have ADS ID cards?
-
7.5 Is there at least one trained person on site in performing First-Aid & CPR?
8. Vehicle
-
8.1. Is the vehicle registration current?
-
8.2. Is the vehicle clean, tidy and organised?
-
Provide photo of cargo compartment of van
-
8.3. Is the vehicle within its service date?
-
8.4. Is the vehicle logbook up to date?
-
8.5. Is there a fire extinguisher available and is it within it's service date?
-
8.6. Does the vehicle have a correctly stocked first aid kit?
-
8.7. Are the location of the fire extinguisher and first aid kit known to staff?
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?
-
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 MSDS's onsite?
-
12.2. Has everyone been trained on these MSDS's?
13. Emergency Response
-
13.1 Are all field personnel onsite familiar with the Emergency Response Procedure applicable to that site?
-
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?
-
13.2 Are St John Fact sheets on site and do all crew members know the location of this sheet?
14. Environmental
-
14.1 Has any sewage spilled outside manhole? (including transfer from equipment or worker exiting manhole)
-
14.1.1. Has the spilled be cleaned up? (shoveling it back into manhole and/or cleaning with disinfectant spray using high pressure washer)
-
14.2 Was any vegetation impacted/removed to access site?
-
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)
-
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)
-
14.4.1 Is the work occurring between 7am-6pm?
-
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?
-
Provide evidence (copy of letter, email or text message notification)
-
14.5 If manhole was sealed prior to opening has it been resealed to prevent odours escaping?
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
- 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
- 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
- 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)
-
Photo of in-manhole worker geared up for entry
-
Photo of Gas meter calibration sticker
-
Photo of Tripod inspection sticker
-
Photo of Winch/RPD inspection sticker
-
Photo of Harness inspection sticker
-
Photo of traffic signage (if applicable)
-
Photo of Traffic management plan (if applicable)
If conducting a remote (telephone) audit- upload photos of documentation here:
-
Photo of completed SWMS sign-off page for relevant Project
-
Photo of completed HIDRA for relevant site
-
Photo of completed Confined Space Permit for relevant site
-
Photo of completed Site Visit Log for relevant site
Corrective Actions and Sign Off
-
Enter any corrective actions that will be undertaken
-
On site representative
-
Auditor's signature