IPPL Site Safety / Environment Inspection Checklist

Information

Conducted on
Project / Client / Site
Job Code
Location
Weather conditions
Conducted by (enter name)
Signature

1 Site Personnel

1.1 Additional Inspection Personnel

Are there additional personnel assisting to undertake the inspection not including the supervisor or other people working on site?
Enter the name of additional personnel undertaking the Inspection.
Name
Signature

1.2 Insituform Site Personnel

Enter Insituform Personnel on site
Name
Position
Signature

1.3 Subcontractors

Are there any Subcontractors on site?
Name of Subcontractor
Supervisor Name

1.4 Insituform Vehicles

Which Insituform Vehicles are on site?
Vehicle Name
Rego Number

2 Access & Egress

Access & Egress / Amenities and Stores

2.1 Work area is tidy and general lighting on site is ok. (Enter details of any issues found)
Enter corrective action taken
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
2.2 Is pedestrian access around work site in place and sufficient? (enter details of any issues found)
Enter corrective action taken
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
2.3 Is appropriate signage correctly displayed, site fenced and all hazards properly barricaded or fenced? (Enter details of any issues found)
Enter corrective action taken
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
2.4 Are any overhead hazards identified and isolated? (Enter details of any issues found)
Enter corrective action taken
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
2.5 Are hoses de-energised prior to disconnection? (Enter details of issues found)
Enter corrective action taken
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
2.6 Are hoses in good condition, secured, isolated and protected? (Insert details of Issue found)
Enter corrective action taken
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
2.7 Are areas on site isolated and protected as needed (Bunding, isolation of Valves)? (Insert details of any issues found)
Enter corrective action taken
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
2.8 Air Hose clamps are secure with safety pins in place? (Insert details of any issue found)
Enter corrective action taken
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
2.9 Are Whip checks used on Stem Hose? (Insert details of any issues found)
Enter corrective action taken
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
2.10 Are barriers and signs in place and in accordance with the Traffic Plan? (Insert Details of any issues found)
Enter corrective action taken
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.

3 Documentation

Documentation

3.1 Have the hazards on site been identified in the SWMS's?
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.2 Are SWMS's available and being followed? Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.3 Has induction training been provided to all personnel on site? Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.4 Are all controls as outlined in the SWMS in place? Enter any details of issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.5 Are any controls highlighted in the Daily Pre-Start activities in place? Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.6 Are all hazardous substances correctly labelled and stored? Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.7 Have the materials or chemicals to be used on site been identified in SWMS's and MSDS Sheets available on site for them? Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.8 Are all MSDS current? (not older then 5 years) Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.9 Are the Approved Plans available on site? (Safety, Quality, Environment and Traffic) Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.10 Are Hazardous Substance signs visible including 'Danger' and 'No Smoking' signs displayed? Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.11 Has the Pre-Start meeting form been completed and signed by all? Enter details of any issues found
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.12 Can workers on site present their physical training cards / tickets to show that they have the required training for certain tasks, e.g. Confined space, construction induction, forklift, etc? Enter details of any issues found
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.
3.13 Have workers been inducted into the project they are working on? What evidence is there to show that this has been completed for staff on site? Enter details of any issues found
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(S)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photos
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photos
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photos
Enter date that corrective action needs to be completed by.

4 Electrical

Electrical

4.1 Are electrical leads, portable equipment and plant Tested and Tagged? Are they current? Enter details of any issues found.
Enter details of any items found not to comply.
Name or type of equipment found non-compliant.
Add photo of non-conforming items / equipment.
Enter corrective action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
4.2 Are portable generators, extension leads and power tools protected with an earth leakage device? Enter details of any Issues found?
Enter corrective action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
4.3 Are all electrical leads elevated and / or protected from damage? Enter details of any issues found
Enter corrective action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.

5 Rescue Plans / Emergency Plans

Rescue Plan / Emergency Plans

5.1 Have fire extinguishers been tested and tagged? (Need to be done every 6 months) Enter details of any Issues found.
Enter Corrective Action Taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
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.
Enter Corrective Action Taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
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.
Enter Corrective Action Taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
5.4 Is a First Aid Kit available in each truck on site? Insert details of any Issues found.
Enter Corrective Action Taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.

6 Confined Space

Confined Space

6.1 Has the Stand By person been recorded on the Confined Space Permit. Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
6.2 Is the role of the responsible person for the confined space understood? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
6.3 Has the Confined Space Permit been filled out and checklist completed? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
6.4 Are all gas monitors ok? faulty ones are tagged out? Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
6.5 Have all signs been displayed and site established correctly for Confined Space work? Enter details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
6.6 Has the gas test response (Bump Test) been recorded and checked for all Gas Meters? Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
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.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
6.8 Is the Access chamber secured and covered if not in use? Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
6.9 Is barricading sufficient to allow the standby person to control unauthorised personnel from entering the area? Enter details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Enter date that corrective action needs to be completed by.
Insert Photo(s)
6.10 Is the person entering the confined space wearing a chin strap to stop their hard hat falling off? Is the stand-by person utilising their chin strap to hold their hard hat in place? Enter details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Enter date that corrective action needs to be completed by.
Insert Photo(s)

Confined Space Equipment

6.11 Are tripod stands complete with leg rope inspected and tagged? Insert details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
6.12 Is the Rescue pulley unit including rope inspected and tagged? Include details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
6.13 Is the rescue harness inspected and tagged? Insert details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
6.14 Is the "DANGER - CONFINED SPACE" sign displayed and visible? Enter details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.

7 Plant & Equipment

Plant & Equipment

7.1 Is all plant & equipment on site inspected prior to working on site and the persons operating them are ticketed / competent? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
7.2 Are all log books, daily checks carried out by the operators? (View Records) Insert details of any Issues found
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
7.3 Are maintenance logs up-to-date? (Visually check) Insert details of any Issues found
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
7.4 Are all Vehicle Inspection Pre-starts up to date for Insituform vehicles? Insert details of any Issues found
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
7.5 Are flammable liquids (Fuel, etc) for the plant and equipment stored in proper containers and labelled? Insert details of any issues found
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
7.6 Are guards provided, Beacon Lights and reversing alarms working on all vehicles? Insert details of any issues found
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
7.7 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
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.

8 Fumes, Noise & Vibration

Fumes

8.1 is there any excessive odour or fumes on site? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.

Noise

8.2 Are Noise levels kept to a minimum where possible? Insert details of any issues found
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.

9 Personal Protective Equipment (PPE)

PPE

9.1 Are hard hats being worn on site by all? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
9.2 Are they in a good condition? I.e. (not cracked or excessively scratched) Enter details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
9.3 Have all hard hats had their date of issue sticker filled in? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
9.4 Are any issued hard hats older then 2 years? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
9.5 is safety footwear being worn by everyone on site? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
9.6 Is all safety footwear in a good condition? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
9.7 Is protective High-Vis clothing being worn? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
9.8 Are long pants and long sleeves being worn by everyone on site? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
9.9 Is other PPE available and being used as required? (e.g. respirators, hearing protection and safety glasses) Insert details of any issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
9.10 Is Sunscreen available? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
9.11 Is PPE Signage displayed? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
9.12 Are chin straps available or are they located on hard hats? Insert details of any Issues found.
Enter Corrective Action taken.
Has this closed out the issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.

10 Environmental

Environment

10.1 Are run off and storm water controls in place? (e.g. silt fence, sand bags) Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
10.2 Are dust control requirements in place? Insert details of any issues found.
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
10.3 Are Safety and Environmental controls appropriate to the weather conditions? Enter details of any issues found.
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
10.4 Is site waste management in place? (all rubbish controlled, cigarette butts controlled) Insert details of any issues found.
Enter Corrective Action taken.
Has this closed out the Issue?
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.

11 Excavations

Excavation

11.1 Are Trenches deeper than 1.5 Metres either Benched, Battered or Boxed (using shoring box)? Insert details of any issues found.
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
11.2 Is a permit in place for excavations and is it approved? Insert details of any issues found
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
11.3 Are handrails required and if so are they appropriate (1 Metre High)? Insert details of any issues found
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
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
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
11.5 Is all spoil clear of the excavation and excavation edge? Insert details of any issues found
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
11.6 Is the access to the excavation clear? Insert details of any issues found
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
11.7 Is an evacuation plan in place and documented? Insert details of any issues found
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
11.8 Is excavated spoil enclosed by a silt fence? Insert details of any issues found
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
11.9 Is the signage around the excavation and work area warning of hazards adequate? Insert details of any issues found
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
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
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
11.11 Are all persons working in the excavation / trench clear when items are being lowered? Insert details of any issues found
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.
11.12 have all hydraulics been inspected with no leaks visible? Is a spill kit available? Insert details of any issues found
Enter details of Corrective Actions taken.
Has this Closed out the Issue.
Take a photo (or photos) of the issue closed out / made safe.
What is the Level of Risk remaining?
Detail required corrective actions to be taken (if known). Action is to be completed by next inspection or within 4 weeks. Insert name of person responsible for carrying out corrective action. Include photos of any corrective action taken.
Insert Photo(s)
Detail required corrective actions to be taken (if known). Action to address the issue is to be completed within 1 day. Provide name of person undertaking / responsible for corrective action. Add any photos of corrective action taken on site.
Insert Photo(s)
Detail required corrective actions to be taken. Action to address this issue must be completed before work can proceed. Provide details of action taken and whom was responsible for them. Include Photo(s).
Insert Photo(s)
Work MUST cease until issue has been investigated and closed out. Detail required corrective actions to be taken (if known). Issue must be reported to the QSE Manager and Supervisor immediately. Provide details of who will be responsible for undertaking corrective action to address / close out the issue. Provide photos of any corrective action immediately taken.
Insert Photo(s)
Enter date that corrective action needs to be completed by.

Incident Documentation

Incident Reports

Do any Incident Report Forms need to be completed for any Issues / Items raised during the Site Inspection?
Detail what actions have been taken to complete these reports and whom is responsible for their completion.

Investigation Reports

Do any Incident Investigation Report Forms need to be completed for any Items / Issues raised today?
Detail who is responsible for these Investigations and what actions have been taken to complete them.

IPPL Site Safety / Environment Inspection Checklist

Go digital today!

Convert your paper checklists into digital forms

1.1 Additional Inspection Personnel

1.2 Insituform Site Personnel

1.3 Subcontractors

1.4 Insituform Vehicles

Access & Egress / Amenities and Stores

Documentation

Electrical

Rescue Plan / Emergency Plans

Confined Space

Confined Space Equipment

Plant & Equipment

Fumes

Noise

PPE

Environment

Excavation

Incident Reports

Investigation Reports

Related checklists

IPPL Site Safety / Environment Inspection Checklist

Free IPPL Site Safety / Environment Inspection Checklist Checklist

Go digital today!

Convert your paper checklists into digital forms

1.1 Additional Inspection Personnel

1.2 Insituform Site Personnel

1.3 Subcontractors

1.4 Insituform Vehicles

Access & Egress / Amenities and Stores

Documentation

Electrical

Rescue Plan / Emergency Plans

Confined Space

Confined Space Equipment

Plant & Equipment

Fumes

Noise

PPE

Environment

Excavation

Incident Reports

Investigation Reports

Related checklists