Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Team

  • Location
  • Activity being undertaken

General Safety and Documentation

  • Do you want to answer the questions on General Safety and Documentation?

  • Has a suitable Point of work risk assessment been completed or checked by Supervisor

  • Has a suitable Permit be completed or checked by Supervisor and being followed by the team.

  • Work activity covered by relevant RAMS and they can locate them and demonstrate they are followed.

  • ID and training cards carried by Supervisor ( in date / relevant for the task being complete)

  • Is the Supervisor wearing the correct PPE and is this in good condition.

Vehicle

  • Do you want to answer the questions on Vehicle?

  • Vehicle has been safety parked having regards public

  • Vehicle in good order, tyres, lights brakes etc and maintained clean and tidy inside

  • Are vehicles and required plant fitted with fully functional amber flashing beacons

  • Tools are stored correctly in the vehicle and secured to avoid damage

  • Supervisor has the correct tools on board vehicle

  • provide details of additional equipment

  • Tools are in good condition, inspected and calibrated

Site Set up

  • Do you want to answer the Site Set Up questions

  • Supervisor have correct NRSWA Accreditation / Registration for the work being executed where required?

  • Supervisor have access to the Red Book - Safety at Street Works and Roads Work on site

  • General site set up in good order and follows the Red Book -Signing, lighting, guarding, Safety zones, Pedestrian Walkway meets / exceeds COP minimum width requirements

  • Site is maintained in a tidy condition, tools, materials stored to avoid hazards.

  • All contractors vehicles positioned safely as per the code of practice.

Hygiene / Welfare

  • Do you wish to answer these questions

  • Do the Team have First Aid supplies on site as required?

  • Are Washing Facilities available on site?

Work within Chambers

  • Do you wish to answer questions relating to accessing or working in chambers

  • Does supervisor have a suitable gas detector which is calibrated and fit for use.

  • Where practical mechanical or other means are being used to reduce the need for manual handling

  • Has the underground network been gas tested and chamber opened correctly

  • Has the chamber been secured and safely signed and guarded to protect the operative and public

  • Supervisor aware of risk from leptospirosis and taking suitable controls.

  • Supervisor aware of the risk of discarded used syringes and have the equipment to deal with them.

Behaviours and Leadership

  • Supervisors demonstrating commitment to health and safety and encouraging contractors/ employees to work safely.

  • Supervisor demonstrates good awareness about the importance of reporting hazards, incidents and injuries and know how to do this using JFL systems.

  • Supervisor demonstrating commitment to ensuring good quality of work and encouraging contractors / employees to strive to provide high quality standards

  • Supervisor demonstrating interest and care in customer experience - demonstrates the ability to understand customer' expectations and needs

  • Supervisor demonstrating willingness and ability to include and collaborate with others to ensure improved operations, compliance and safety

  • Supervisor demonstrating behaviors which are appropriate to demonstrate integrity, accepting of own responsibility and accountability, dealing with other employees honestly and fairly.

  • Supervisor demonstrates a good understanding of company policy and procedures and is behaving in an appropriate manner to adhere to these.

  • Supervisor demonstrating ability to solve problems and help others to find suitable solutions -thinking out of the box and going that extra mile.

  • Supervisors demonstrating good communication skills and engaging well with employees /contractors

  • Other notable Good Practice seen

Sign Off and Learning

  • Provide details of any learning or action agreed for the Supervisors

  • Supervisor sign to identify they understand the finding of the Inspection

  • Inspector sign to demonstrate the Inspection is a record of the findings

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.