Information
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Location
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Job number
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Conducted on
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Conducted by
1. Working at Heights
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Fall risks of 2m or more? (including voids, pits, and trenches)
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Lack of edge protection?
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Unsafe or incomplete edge protection?
2. Plant and Equipment
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Unsafe or damaged plant/equipment? (including missing or damaged guards)
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Incorrect plant /equipment for job? (e.g. grinding discs for cutting)
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Unsafe or incompatible attachments used with plant/equipment?
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Unlicensed operators?
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Lack of safe work instructions?
3. Scaffolds
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Unlicensed persons erecting scaffold above 4m?
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Unsafe or incomplete scaffold?
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Lack of inspection protocol for scaffold?
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Incompatible scaffold components? Unlabeled or do not meet AS?
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Safe Work Load (SWL) exceeded? (tools, stored materials, number of persons)
6. Ladders
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Unsafe or damaged ladders?
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Unsafe positioning of ladders?
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Ladder not properly secured?
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Ladder unsuitable for job? (e.g. metal ladder used for electrical work)
10. Traffic Management
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Lack of, or inadequate, Traffic Management Plan (TMP) in place?
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Lack of training in TMP for all persons on site? <br>(contractors and visitors)
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Inadequate controls for TMP? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)
11. Personal Protective Equipment (PPE)
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Lack of, or inadequate PPE (including sun protection)
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Lack of system to issue, inspect, replace and monitor PPE?
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Lack of training in safe use, clean-up and inspection of PPE?
12. Work Environment
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Lack of/or inadequate amenities? (toilets, wash areas, lunch rooms, etc)
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Inadequate housekeeping?
Corrective Actions
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Enter any corrective actions that will be undertaken
Sign Off
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Auditor's signature
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Date
