Kembla Watertech Safety Inspection Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Project Information

• Client

• Contract Number

• Crew

• Select date

  Date

• Location

• Persons in attendance at Inspection

D~Confined space

• D1-Has gas monitor been response tested and recorded on the appropriate documentation?

  Yes

  No

  N/A

• D2-Serial number of gas monitor

• D3-Calibration due date

• D4-Is the gas monitor within calibration date?

  Yes

  No

  N/A

• D5-Has testing of the maintenance hole been recorded on entry permit or daily risk assessment sheet?

  Yes

  No

  N/A

• All employees entering the confine space are currently trained?

  Yes

  No

  N/A

• D6-Employees confined spaces certificate number

• D7-Standby person currently confined space trained?

  Yes

  No

  N/A

• D8-Who is the nominated person for maintenance hole entry?

• D9-Who is the nominated person for standby duties?

• D10-Are current confined space procedures being followed?

  Yes

  No

  N/A

• D11-Has the confined space entry permit been filled out?

  Yes

  No

  N/A

• What is the permit number?

• D12-Are the chemicals used in confined spaces nominated on the confined space entry permit?

  Yes

  No

  N/A

• D13-Are all applicable section addressed by either a tick or N/A?

  Yes

  No

  N/A

• D14-Has the responsible person signed off where required?

  Yes

  No

  N/A

• D15-Is there an approved tripod on site?

  Yes

  No

  N/A

• D16-Is the tripod engraved with an ID number?

  Yes

  No

  N/A

• What is the ID number?

• D17-Is the tripod fully extended?

  Yes

  No

  N/A

• D18-Is there an full parachute type harness on site?

  Yes

  No

  N/A

• D19-Is the harness in good condition?

  Yes

  No

  N/A

• D20-Is there an air rescuer on site and within its 10 year date?

  Yes

  No

  N/A

• D21-What is the serial number of the harness?

• D22-Is there a grate covering unattended maintenance hole?

  Yes

  No

  N/A

• D23-Is there signage out "Confined space entry by permit only"?

  Yes

  No

  N/A

• D24-Is there a grate covering unattended maintenances hole?

  Yes

  No

  N/A

• D25-Is there signage out "Confined space entry by permit only?

  Yes

  No

  N/A

E~Civils

• E1-Have the safe work method statements been identified for this process?

  Yes

  No

  N/A

• E2-Is there dial before you dig information on site?

  Yes

  No

  N/A

• E3-What is the job number on the dial before you dig caller information sheet?

• E4- Has the dig cut permit (QF 137) been completed?

  Yes

  No

  N/A

• E5-Has precautions been taken to positively identify and locate the position and lie of any underground services, before excavation has started?

  Yes

  No

  N/A

• E6-Has work area been barricaded, bollards placed and sign posted to warn resident or pedestrians of potential hazards?

  Yes

  No

  N/A

• E7-(A) Has trench/excavation been identified as a confined space?

  Yes

  No

  N/A

• (B) Is there a escape/access route in place?

  Yes

  No

  N/A

• (C) Is there a gas monitor in position?

  Yes

  No

  N/A

• (D) Is the self rescuer within reach?

  Yes

  No

  N/A

• E8-Trenches 1.5m or more in depth correctly shored or battered?

  Yes

  No

  N/A

• E9-Edge of trench clear of soil (minimum 1000mm)?

  Yes

  No

  N/A

• E10-Correct techniques being used when lowering items into trench?

  Yes

  No

  N/A

• E11-Persons in trench clear when lowering items into trench?

  Yes

  No

  N/A

• E12-Ladders used are adequate and in good condition?

  Yes

  No

  N/A

• E13-Ladders secured correctly, at right height and angle?

  Yes

  No

  N/A

F~Ex method

• F1-Have the correct safe work method statements been identified for this process?

  Yes

  No

  N/A

• F2-Persons been instructed on the work instruction for EX lining?

  Yes

  No

  N/A

• F3-Has a hot work permit been completed to work instruction (W1012)?

  Yes

  No

  N/A

• F4-(a) have employees been provided with appropriate P.P.E for this process?

  Yes

  No

  N/A

• (b)Leather gloves

  Yes

  No

  N/A

• (C)Eye protection

  Yes

  No

  N/A

• (d)Leather arm guards

  Yes

  No

  N/A

• (e)Dust mask/respirator

  Yes

  No

  N/A

• F5-Are these being worn?

  Yes

  No

  N/A

• F6-Is there a current boiler certificate on the truck?

  Yes

  No

  N/A

• F7-Does the standpipe have a back flow prevention device attached?

  Yes

  No

  N/A

• F8-Is there a current certificate for the backflow prevention devise?

  Yes

  No

  N/A

• F9-Are the steam hoses in satisfactory condition?

  Yes

  No

  N/A

• F10-Does tray need to be decreased?

  Yes

  No

  N/A

• F11-Truck crane free of leaks?

  Yes

  No

  N/A

G~Tiger tees/Patching

• G1-Have the safe work method statements been identified for this process?

  Yes

  No

  N/A

• G2-Persons been instructed on the work instruction for EX lining?

  Yes

  No

  N/A

• G3-Are employees or the public protected from the winch when it is able to start?

  Yes

  No

  N/A

• G4-(a) have employees been provided with appropriate P.P.E for this process?

  Yes

  No

  N/A

• (b)Dust mask/respirator

  Yes

  No

  N/A

• (c)Inorganic filters A1,B1,E1,P3 survivor

  Yes

  No

  N/A

• (d)Full face shield

  Yes

  No

  N/A

• (e)Rubber apron

  Yes

  No

  N/A

• G5-Are resins containers correctly labelled?

  Yes

  No

  N/A

• G6-Is quality QF063 camera ipex,equipment gas register being completed?

  Yes

  No

  N/A

H~CCTV/Jetting

• H1-Have the safe work method statements been identified for this process?

  Yes

  No

  N/A

• H2-(a)Have employees been instructed on work instruction WI034 high pressure water jetting mainlines?

  Yes

  No

  N/A

• (b)Have employees been instructed on safe work method statement WMS003 clean and CCTV sewer conduit?

  Yes

  No

  N/A

• H3-Is the jetted hose in good condition?

  Yes

  No

  N/A

• H4-Access to the vehicle acceptable?

  Yes

  No

  N/A

• H5-Is there a 110mm to prevent backflow from the jetted reservoir?

  Yes

  No

  N/A

• H6-Is there a backflow prevention device on the standpipe?

  Yes

  No

  N/A

• H7-Is there a current certificate for the backflow prevention device?

  Yes

  No

  N/A

• H8-Is quality form QF053 camera ipex, equipment gas recording register being completed?

  Yes

  No

  N/A

I~Traffic control

• I1-Is there an approved traffic control plan in use?

  Yes

  No

  N/A

• I2-What is the traffic control plan number?

• I3-Are advisory signs as per the traffic control plan selected?

  Yes

  No

  N/A

• I4-Is there a requirement for traffic controllers?

  Yes

  No

  N/A

• I5-Does the controller have a current traffic controllers certificate?

  Yes

  No

  N/A

• I6-Are on site traffic controllers certified (level2)? What are there names?

• I7-Is there a requirement for a certified traffic control agency?

  Yes

  No

  N/A

• I8-Does the traffic control agency have an approved traffic management plan approved by Main Roads or council on site?

  Yes

  No

  N/A

• I9-Has a representative from Kembla Watertech sighted the traffic control plan?

  Yes

  No

  N/A

• I10-Sufficent advisory signs used and correctly placed?

  Yes

  No

  N/A

• I11-Is there access around the worksite for the public?

  Yes

  No

  N/A

• I12-Is there a yellow card holder on site? What is there name and card number?

• I13-Is there armed card holder on site? What is there name a card number?

• I14-Is there a current RTA ROL on site?

  Yes

  No

  N/A

• I15-What is the ROL number?

• I16-Is there a current speed reduction in place?

  Yes

  No

  N/A

• I17-What is the speed reduction certificate number?

• I18-Is there a current council permit on site?

  Yes

  No

  N/A

• I19-Is there a current approved police permit on site?

  Yes

  No

  N/A

• I20-Are there adequate spare signs on site if required?

  Yes

  No

  N/A

• I21-Is there a copy QF006 traffic control site appraisal on site?

  Yes

  No

  N/A

• I22-Is there a copy of QF015 on site daily inspection checklist on site?

  Yes

  No

  N/A

• I23-Is there a copy of QF030-1 traffic control management HIDRA on site?

  Yes

  No

  N/A

• I24-Are all traffic controllers correctly situated?

  Yes

  No

  N/A

• I25-Is there a qualified relief person on site?

  Yes

  No

  N/A

• I26-Are traffic controllers wearing correct vest or night overalls?

  Yes

  No

  N/A

• I27-Is signage in good condition?

  Yes

  No

  N/A

• I28-Do traffic controllers have escape routes?

  Yes

  No

  N/A

• I29-Are there night wands on site if required?

  Yes

  No

  N/A

• I30-Are pedestrians and cyclist catered for at site?

  Yes

  No

  N/A

• I31-Are beacons and arrows boards on traffic control vehicles functioning correctly?

  Yes

  No

  N/A

J~Signage

• J1-Is there 2 of pedestrians watch your step signs?

  Yes

  No

  N/A

• J2-Is there 2 of part road closed signs?

  Yes

  No

  N/A

• J3-Is there 4 of dig man ahead signs left and right?

  Yes

  No

  N/A

• J4-Is there 2 of chevron signs left and right?

  Yes

  No

  N/A

• J5-Is there a clients information sign on site?

  Yes

  No

  N/A

• J6-Is there a confindwd space entry sign?

  Yes

  No

  N/A

• J7-Condition of signage

  Good

  Poor

K~Plant

• K1-Plant/Vehicle operator licensed?

  Yes

  No

  N/A

• Driver or operators name?

• Class of drivers license or work cover ticket number?

• K2-Visual inspection of plant.

  Safe

  At Risk

  N/A

• K3-(a)Registration and expiry date?

• (b)Tyres

  Pass

  Fail

• (c)Headlights

  Pass

  Fail

• (d)Indicators

  Pass

  Fail

• (e)Tail lights

  Pass

  Fail

• (f)Brake lights

  Pass

  Fail

• (g)Horn working

  Pass

  Fail

• (h)Windscreen

  Pass

  Fail

• (I)Bodywork

  Pass

  Fail

• (j)Hydraulics

  Pass

  Fail

• (k)Towing mechanism secure

  Pass

  Fail

• K4-Is the cabin clean and tidy?

  Yes

  No

  N/A

• K5-Is there a spare tyre and jack for this unit?

  Yes

  No

  N/A

• K6-DANGER notice attached and clearly visible to operator?

  Yes

  No

  N/A

• K7-CAUTION notice attached and clearly visible to operator?

  Yes

  No

  N/A

• K8-Is there safe access onto or into the vehicle (steps ladder etc)?

  Yes

  No

  N/A

• K9-Has log book for truck mounted crane completed for that day?

  Yes

  No

  N/A

• K10-Is the work area of vehicle clean and tidy and equipment stored correctly?

  Yes

  No

  N/A

• K11-Does this plant tow a compressor-trailer?

  Yes

  No

  N/A

• (a)Registration number and expiry date?

• (b)Tyres

  Pass

  Fail

• (c)Indicators

  Pass

  Fail

• (d)Tail lights

  Pass

  Fail

• (e)Brake lights

  Pass

  Fail

• (f)Towing mechanism secure

  Pass

  Fail

L~Scaffolding

• L1-Is the scaffold more than four meters high?

  Yes

  No

  N/A

• L2-Who erected the scaffolding?

• L3-Certificate sighted and number?

• L4-Is the scaffold secure and stable?

  Yes

  No

  N/A

• L5-Are there the required top and middle hand rails attached (after 1.8m)

  Yes

  No

  N/A

• L6-is the platform fully decked?

  Yes

  No

  N/A

• L7-Are to boards fitted?

  Yes

  No

  N/A

M~Electrical

• M1-Electrical leads,portable equipment and plant tested and tagged?

  Yes

  No

  N/A

• M2-Portable generators,extension leads/power tools protected with earth leakage device?

  Yes

  No

  N/A

• M3-Is the earth lead being used?

  Yes

  No

  N/A

• M4-Electrical log book on site for this vehicle?

  Yes

  No

  N/A

• M5-Is the electrical log book completed correctly?

  Yes

  No

  N/A

N~Slings

• N1-Persons slings used and in good condition?

  Yes

  No

  N/A

• N2-Correct slings used and in food condition?

  Yes

  No

  N/A

• N3-Is a lead robe used to control loads where necessary?

  Yes

  No

  N/A

O~Housekeeping

• O1-Work area tidy and materials stored properly?

  Yes

  No

  N/A

• O2-Are all the steam hoses checked for leaks?

  Yes

  No

  N/A

• O3-Noise requirements being adhered to?

  Yes

  No

  N/A

• O4-All rubbish and cigarette butts removed from site?

  Yes

  No

  N/A

• O5-Are bins being used?

  Yes

  No

  N/A

• O6-Are start times being adhered to. No work prior to 0700h.

  Yes

  No

  N/A

• O7-Are the steal fittings covered to eliminate burns?

  Yes

  No

  N/A

Comments

• Are there any further comments to add?

Inspection details

• Inspectors name?

• Inspectors signature.

  Sign

• Select date

  Date

• Witness name.

• Witness signature.

  Sign

• Select date

  Date