Information
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Conducted on
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Project / Client / Site
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Job Code
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Location
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Weather conditions
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Conducted by (enter name) & Signature
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Site Supervisor Name
1 Site Personnel
1.1 Additional Inspection Personnel
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Are there additional personnel assisting to undertake the inspection not including the supervisor or other people working on site?
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Enter the name of additional personnel undertaking the Inspection.
Additional Inspection Personnel
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Name
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Enter Insituform Personnel on site
Name
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Name
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Position
1.2 Subcontractors
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Are there any Subcontractors on site?
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Name of Subcontractor
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Supervisor Name
2 Access & Egress
Access & Egress / Amenities and Stores
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2.1 Work area is tidy and general lighting on site is ok. (Enter details of any issues found)
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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2.2 Is pedestrian access around work site in place and sufficient? (enter details of any issues found)
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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2.3 Is appropriate signage correctly displayed, site fenced and all hazards properly barricaded or fenced? (Enter details of any issues found)
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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2.4 Are any overhead hazards identified and isolated? (Enter details of any issues found)
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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2.5 Are hoses de-energised prior to disconnection? (Enter details of issues found)
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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2.6 Are hoses in good condition? Are they secured (whip checks and safety pins used)? (Insert details of Issue found)
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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2.9 Is site housekeeping of an acceptable standard? (Insert details of any issues found)
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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2.10 Are barriers and signs in place and in accordance with the Traffic Plan? (Insert Details of any issues found)
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
3 Documentation
Documentation
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3.1 Have the hazards on site been identified in the SWMS's?
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.2 Are SWMS's available and being followed? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.3 Are all controls as outlined in the SWMS in place? Enter any details of issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.4 Has induction training been provided to all personnel on site? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.5 Has the pest art meeting form been completed and signed? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.6 Are any controls highlighted in the Daily Pre-Start activities in place? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.7 Are all hazardous substances correctly labelled and stored? (Including fuel for plant & equipment) Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.8 Are all MSDS current? (not older then 5 years) Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.19 Are Hazardous Substance signs visible including 'Danger' and 'No Smoking' signs displayed? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.10 Are the Approved Plans available on site? (Safety, Quality, Environment and Traffic) Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
4 Electrical
Electrical
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4.1 Are electrical leads, portable equipment and plant Tested and Tagged? Are they current? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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4.2 Are portable generators, extension leads and power tools protected with an earth leakage device? Enter details of any Issues found?
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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4.3 Are all electrical leads elevated and / or protected from damage? Enter details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
5 Rescue Plans / Emergency Plans
Rescue Plan / Emergency Plans
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5.1 Have fire extinguishers been tested and tagged? (Need to be done every 6 months) Enter details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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5.2 Are first aid kits sufficiently stocked and are all items in date? Do all items have a use by date? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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5.3 Are all first aiders identified on site along with relevant contact numbers (000 and First Aider contact no, etc) Enter details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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5.4 Is a First Aid Kit available in each truck on site? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
6 Confined Space
Confined Space
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6.1 Has the Confined Space Permit been filled out and checklist completed? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.2 Has the Stand By person been recorded on the Confined Space Permit. Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.3 Is the role of the responsible person for the confined space understood? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.4 Are all gas monitors ok? faulty ones are tagged out? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.5 Have all signs been displayed and site established correctly for Confined Space work? Enter details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.6 Has the gas test response (Bump Test) been recorded and checked for all Gas Meters? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.7 If gas has been identified in the confined space is ventilation (either forced or natural) in place? Enter details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.8 Is the Access chamber secured and covered if not in use? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
Confined Space Equipment
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6.10 Are tripod stands inspected and tagged? Insert details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.11 Is the Rescue pulley unit including rope inspected and tagged? Include details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.12 Is the rescue harness inspected and tagged? Insert details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.13 Is the "DANGER - CONFINED SPACE" sign displayed and visible? Enter details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
7 Plant & Equipment
Plant & Equipment
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7.1 Is all plant & equipment on site inspected prior to working on site and the persons operating them are ticketed / competent (cranes, excavators, etc)? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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7.2 Are all log books, daily checks carried out by the operators? And maintenance logs up to date? (View Records) Insert details of any Issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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7.3 Are all Vehicle Inspection Pre-starts up to date for Insituform vehicles? Insert details of any Issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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7.5 Are guards provided, Beacon Lights and reversing alarms working on all vehicles? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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7.6 Is all lifting gear in a good condition? Is a Certification / Lifting Gear Register available for all lifting gear? Insert details of any Issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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7.7 Is a safe working area defined around plant and equipment(e.g. Exclusion zones)? Insert details of any Issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
8 Fumes, Noise & Vibration
Fumes
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8.1 is there any excessive odour or fumes on site? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
Noise
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8.2 Are Noise levels kept to a minimum where possible? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
9 Personal Protective Equipment (PPE)
PPE
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9.1 Are hard hats being worn on site by all? And are they in good condition? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.2 is safety footwear being worn by everyone on site? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.3 Is all safety footwear in a good condition? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.4 Is protective High-Vis clothing being worn? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.5Are long pants and long sleeves being worn by everyone on site? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.6Is other PPE available and being used as required? (e.g. respirators, hearing protection and safety glasses) Insert details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.7 Is Sunscreen available? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.8 Is PPE Signage displayed? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
10 Environmental
Environment
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10.1 Are run off and storm water controls in place? (e.g. silt fence, sand bags) Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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10.2 Are dust control requirements in place? Insert details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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10.3 Are Safety and Environmental controls appropriate to the weather conditions? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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10.4 Is site waste management in place? (all rubbish controlled, cigarette butts controlled) Insert details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
11 Excavations
Excavation
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11.1 Are Trenches deeper than 1.5 Metres either Benched, Battered or Boxed (using shoring box)? Insert details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.2 Is a permit in place for excavations and is it approved? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.3 Are handrails required and if so are they appropriate (1 Metre High)? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.4 Are overhead and buried services assessed and a safe system of work deployed? Has DBYD (Dial Before You Dig) been completed? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.5 Is all spoil clear of the excavation and excavation edge? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.6 Is the access to the excavation clear? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.7 Is an evacuation plan in place and documented? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.8 Is excavated spoil enclosed by a silt fence? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.9 Is the signage around the excavation and work area warning of hazards adequate? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.10 Is the hitching pin in place on any excavators to ensure that no buckets can come free from the machine? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.11 Are all persons working in the excavation / trench clear when items are being lowered? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.12 have all hydraulics been inspected with no leaks visible? Is a spill kit available? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
