Information
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Conducted on
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Project / Client / Site
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Job Code
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Location
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Weather conditions
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Conducted by (enter name) & Signature
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Site Supervisor Name
1 Site Personnel
1.1 Additional Inspection Personnel
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Are there additional personnel assisting to undertake the inspection not including the supervisor or other people working on site?
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Enter the name of additional personnel undertaking the Inspection.
Additional Inspection Personnel
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Name
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Enter Insituform Personnel on site
Name
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Name
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Position
1.2 Subcontractors
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Are there any Subcontractors on site?
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Name of Subcontractor
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Supervisor Name
2 Organisation and Administration
Organisation & Administration
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2.1 Project Plans are available on Site (SMP, QMP, EMP, TMP) where required. (Enter details of any issues found)
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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2.2 Are Incident, Injury and Close Call forms available on site? (enter details of any issues found)
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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2.3 Are SWMS's and Work Instructions available? (Enter details of any issues found)
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
3 Documentation
Pre-Start Meeting
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3.1 Pre-Start completed and signed by all? Visitors Register used for Visitors?
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.2 Emergency Evacuation Point identified for the site? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.3 Are the SWMS's identified? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.4 Is Work Pack completed up to and appropriate for the status of work? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.5 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.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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3.6 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.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
4 Site Risks
Site Risks
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4.1 Site barricaded and isolated from the Public? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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4.2 Are safety pins and whip checks used on all hoses? Enter details of any Issues found?
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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4.3 Is traffic control set up as per nominated TC Plan?
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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4.4 Are pedestrian movements managed on site?
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
5 First Aid
First Aid
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5.1 First Aid kits easily accessible, clean, tidy and stocked? Enter details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
6 Confined Space
Confined Space
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6.1 Barricades and signage installed around manholes? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.2 Gas Monitors tested and fully charged? Calibration Current? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.3 Has the gas response (Bump Test) been recorded and checked for all the Gas Monitors? Is the Gas test bottle in Date? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.4 Confined Space equipment current and tagged? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.5 Confined Space Entry Permit completed? Enter details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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6.6 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.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
7 Electrical
Electrical
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7.1 Portable hand tools tested and tagged (and current)? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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7.2 Extension leads & RCD's are in good working order? Insert details of any Issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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7.3 Are extension leads correctly positioned? Insert details of any Issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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7.4 Are power points clean & Undamaged? Insert details of any Issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
8 Dangerous Goods & Equipment
Dangerous Goods and Equipment
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8.1 Appropriate warning signs displayed in work areas? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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8.1 Appropriate warning signs displayed in work areas? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
9 Personal Protective Equipment (PPE)
PPE
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9.1 Are hard hats being worn on site by all? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.2 Are they in a good condition? I.e. (not cracked or excessively scratched) Enter details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.3 is safety footwear being worn by everyone on site? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.4 Is all safety footwear in a good condition? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.5 Is protective High-Vis clothing being worn? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.6 Are long pants and long sleeves being worn by everyone on site? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.7 Are safety glasses being worn by everyone on site? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.8 Is other PPE available and being used as required? (e.g. respirators, hearing protection and safety glasses) Insert details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.9 Is Sunscreen available? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.10 Is PPE Signage displayed? Insert details of any Issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
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9.11 Are chin straps available or are they located on hard hats?
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the issue?
10 Environmental
Environment
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10.1 Are run off and storm water controls in place? (e.g. silt fence, sand bags) Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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10.2 Are dust control requirements in place? Insert details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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10.3 Are Safety and Environmental controls appropriate to the weather conditions? Enter details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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10.4 Is site waste management in place? (all rubbish controlled, cigarette butts controlled) Insert details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
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10.5 Is Odour Mitigation Checklist completed and controls in place? Insert details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this closed out the Issue?
11 Excavations
Excavation
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11.1 Are Trenches deeper than 1.5 Metres either Benched, Battered or Boxed (using shoring box)? Insert details of any issues found.
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.2 Is a permit in place for excavations and is it approved? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.3 Are handrails required and if so are they appropriate (1 Metre High)? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.4 Are overhead and buried services assessed and a safe system of work deployed? Has DBYD (Dial Before You Dig) been completed? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.5 Is all spoil clear of the excavation and excavation edge? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.6 Is the access to the excavation clear? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.7 Is an evacuation plan in place and documented? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.8 Is excavated spoil enclosed by a silt fence? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.9 Is the signage around the excavation and work area warning of hazards adequate? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.10 Is the hitching pin in place on any excavators to ensure that no buckets can come free from the machine? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.11 Are all persons working in the excavation / trench clear when items are being lowered? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
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11.12 have all hydraulics been inspected with no leaks visible? Is a spill kit available? Insert details of any issues found
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Enter corrective action taken or the action required to address the issue. Who will be responsible for the actions required.
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Has this Closed out the Issue.
12 Housekeeping
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12.1 Is Site clean and free of rubbish? Enter details of any issues found.
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Enter corrective action taken or action required to address the issue. Who will be responsible for undertaking the corrective action?
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Has this closed out the issue?
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12.2 Are the trucks and their work areas tidy? Free of rubbish? Equipment stored neatly? Enter details of any issues found.
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Enter corrective action taken or action required to address the issue. Who will be responsible for undertaking the corrective action?
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Has this closed out the issue?
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12.3 Are the truck cabs tidy? Free of rubbish? Equipment not stored in them? Enter details of any issues found.
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Enter corrective action taken or action required to address the issue. Who will be responsible for undertaking the corrective action?
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Has this closed out the issue?
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12.4 Are the truck bodies clean? Enter details of any issues found.
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Enter corrective action taken or action required to address the issue. Who will be responsible for undertaking the corrective action?
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Has this closed out the issue?
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12.5 Have vehicle checklists been completed? Are issues identified being actioned? Enter details of any issues found.
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Enter corrective action taken or action required to address the issue. Who will be responsible for undertaking the corrective action?
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Has this closed out the issue?
