Internal Field Safety Inspection - duplicate

• Personnel

• Inspection date

  Date

• Prepared by

• Site ID

• Address
  Address

• Audit #

1. Traffic control

• 1.1. Is traffic plan on site and effective

  Yes

  No

  N/A

• 1.2. Is site setup in accordance with traffic plan

  Yes

  No

  N/A

• 1.3. Stop/slow signs used correctly

  Yes

  No

  N/A

• 1.4. Hazard lights/beacons in use

  Yes

  No

  N/A

• 1.5. Are all staff correctly certified

  Yes

  No

  N/A

2. Personal safety

• 2.1. Hi viz clothing being worn by all

  Yes

  No

  N/A

• 2.2. Protective pants and jackets being worn

  Yes

  No

  N/A

• 2.3. Protective waders being worn

  Yes

  No

  N/A

• 2.4. Protective gloves being worn

  Yes

  No

  N/A

• 2.5. Steel capped boots worn

  Yes

  No

  N/A

• 2.6. Hard hats being used appropriately?

  Yes

  No

  N/A

• 2.7. Harness condition acceptable

  Yes

  No

  N/A

• 2.8. Safety rope/ RPD condition acceptable?

  Yes

  No

  N/A

• 2.9. Safety rope correctly used?

  Yes

  No

  N/A

• 2.10. Oxybox available?

  Yes

  No

  N/A

• 2.11. Ear muffs or ear plugs available?

  Yes

  No

  N/A

• 2.12. Is nearest hospital known by crew

  Yes

  No

  N/A

• 2.13. Are mobile phones on and easily accessible?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 2.15. Sunscreen and insect repellant available?

  Yes

  No

  N/A

• 2.16. Are safety glasses available

  Yes

  No

  N/A

• 2.17. Is hand cleaner or paper towel available

  Yes

  No

  N/A

3. Gas meters

• 3.1. Is gas meter response test recorded?

  Yes

  No

  N/A

• 3.2. Is the gas meter within the test period?

  Yes

  No

  N/A

• 3.3. Has manhole been checked?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

4. Equipment

• 4.1. Is tripod correctly installed?

  Yes

  No

  N/A

• 4.2. Is tool bucket being used appropriately

  Yes

  No

  N/A

• 4.3. Is all equipment stored correctly?

  Yes

  No

  N/A

• 4.4. Are tools clean and stored appropriately

  Yes

  No

  N/A

• 4.5. Is the drill operational and properly maintained?

  Yes

  No

  N/A

• 4.6. Is all equipment within calibration?

  Yes

  No

  N/A

• 4.7. Is all electrical equipment inspected and tagged?

  Yes

  No

  N/A

5. Operation

• 5.1. Is top operator in verbal contact with man in pit?

  Yes

  No

  N/A

• 5.2. Is top site clean and tidy?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 5.4. Is the work area fenced off safely?

  Yes

  No

  N/A

• 5.5. Are the appropriate signs placed to warn the public?

  Yes

  No

  N/A

• 5.6. Does the pygmy/prop have a current certificate?

  Yes

  No

  N/A

6. Paperwork

• 6.1. Has the confined space permit been completed?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 6.4. Has the risk assessment been updated?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 6.6. Is there a current and approved PSP onsite?

  Yes

  No

  N/A

• 6.7. Has the site visit log been updated?

  Yes

  No

  N/A

• 6.8. Has the daily been completed?

  Yes

  No

  N/A

• 6.9. Is all paperwork logical and legible?

  Yes

  No

  N/A

7. Certification

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 7.3. Do all people onsite have valid SWC passports?

  Yes

  No

  N/A

• 7.4. Do all people have ADS ID tags?

  Yes

  No

  N/A

• 7.5. Do all people onsite have a SWC ID card?

  Yes

  No

  N/A

8. Vehicle

• 8.1. Is the vehicle rego current?

  Yes

  No

  N/A

• 8.2. Is the vehicle clean and tidy?

  Yes

  No

  N/A

• 8.3. Is the vehicle with its service date?

  Yes

  No

  N/A

• 8.4. Is there a Fire Extinguisher available and in calibration?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 8.6. 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

• 9.2. Are the cables secured neatly?

  Yes

  No

  N/A

• 9.3. Are the hydraulics safe for entry?

  Yes

  No

  N/A

10. Rescue simulation exercise

• 10.1. Was the rescue simulation carried out effectively?

  Yes

  No

  N/A

• 10.2. How deep was manhole?

  Yes

  No

  N/A

• 10.3. How fast was the rescue?

  Time

11. Safe Work Method Statements

• 11.1. Are SWMS onsite?

  Yes

  No

  N/A

• 11.2. Were the SWMS reviewed and followed?

  Yes

  No

  N/A

12. MSDS

• 12.1. Are all relevant MSDS's onsite?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

• 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