KINGFISHER LABOUR HIRE SITE SAFETY INSPECTION

• Conducted on

  Date

• Prepared by

• Location
  Address

• Company name:

• BH Company ID No:

• Client Representative Full Name:

• Position:

• Phone:

• Email:

• Type of work

  Select Labour Trades Maintenance Supervisor / Managment Mobile or Locum White Collar / Office

  • Labour
  • Trades
  • Maintenance
  • Supervisor / Managment
  • Mobile or Locum
  • White Collar / Office

• Other (specify)

• Estimated assignment duration (in weeks)

• Estimated No of LH Workers

• Information obtained will only be used to assist in the completion of this site inspection report, will remain confidential and will only be used for purposes associated with the agreed Terms of Business in place.

• This report has been prepared by a Kingfisher representative for the sole purpose of assessing the standard of the health and safety management of a host employers Site Location and assignment.

• EXECUTED by Kingfisher Recruitment Pty Ltd ACN 113 433 177 with its registered office at Level 12, 473 Bourke Street, Melbourne, VIC 3000

• by being signed by:

• Signature:

  Sign

• Dated:

  Date

• Do you on-hire workers for other clients?

  Yes

  No

  N/A

• Is there a company WHS manual or is there a formal WHS Management system in place?

  Yes

  No

  N/A

• Can you provide evidence of how you manage safety and mitigate risk?

  Yes

  No

  N/A

• Yes

  No

  N/A

Documentation and Systems:

• Do you have available SWMS/JSEA, risk assessments and safe work/operating procedures (SOP) for tasks associated with this assignment?

  Yes

  No

  N/A

• Do you have a documented policy for:

• Work health and safety

  Yes

  No

  N/A

• Bullying, harassment, and discrimination

  Yes

  No

  N/A

• Mental health at work

  Yes

  No

  N/A

• Alcohol and other drugs

  Yes

  No

  N/A

• Do you have documented procedures for:

• Risk management

  Yes

  No

  N/A

• Induction and training

  Yes

  No

  N/A

• Incident management

  Yes

  No

  N/A

• working alone/mobile/remote work

  Yes

  No

  N/A

• emergency & First Aid

  Yes

  No

  N/A

• electrical safety

  Yes

  No

  N/A

• Please identify any additional hazards that are specific to the site/task and provide copies of associated procedures:

Personal Protective Equipment (PPE)

• You agree to supply and provide Kingfisher on-hire workers with the required PPE for the assignment and tasks asociated

  Yes

  No

  N/A

• What is the reason for not doing so?

  Yes

  No

  N/A

• Workers have been provided with information, training, and instruction on the proper use and wearing of PPE?

  Yes

  No

  N/A

Traffic Management

• Has the company prepared a traffic management plan for the site(s)?

  Yes

  No

  N/A

• A SWM is available for all work that is carried out on, in or adjustment to:

• Road

  Yes

  No

  N/A

• Railway

  Yes

  No

  N/A

• Plant and Equipment Paths

  Yes

  No

  N/A

• Pedestrian walkways

  Yes

  No

  N/A

OHS TRAINING AND INDUCTIONS

• Do you have a formal induction process, and provision of ongoing information, instruction, and training for on-hire workers?

  Yes

  No

  N/A

• Do you provide task specific training & verification of competency for on-hire workers? Use of e.g., use of power tools, machine operation

  Yes

  No

  N/A

• Are on-hire workers required to hold any specific high-risk licenses or clearances? (working with children, police check, forklift etc.).

  Yes

  No

  N/A

• Please List what is required:

• Is it likely that on-hire workers on placement will be required to work alone?

  Yes

  No

  N/A

• Do you have a working alone safety procedure and risk assessment??

  Yes

  No

  N/A

• Is on-hire staff provided with adequate training on these procedures?

  Yes

  No

  N/A

• Are you aware that you must notify us if an on-hire worker is involved in an accident, including a near miss?

  Yes

  No

  N/A

• How will this be done?

• Has the company ever been convicted of a work health and safety offence?

  Yes

  No

  N/A

• Are emergency evacuation and first aid procedures implemented and readily available to on-hire workers?

  Yes

  No

  N/A

• How is first aid managed?

• First aid equipment has been provided for the workplace and is accessible for each worker?

  Yes

  No

  N/A

• Adequate number of workers on site have been trained to administer first aid?

  Yes

  No

  N/A

• How is this managed?

• The first aid provisions for the workplace are appropriate to the nature of the work being carried out, hazards in the workplace and size and location of the workplace?

  Yes

  No

  N/A

EMERGENCY CONTACTS:

• CLOSEST HOSPITAL:

• CLOSEST DOCTOR:

CHANGES TO ASIGNMENT

• Are you aware that you are required to notify Kingfisher Recruitment in the event that an on-hire worker is required to perform alternative duties, duties at a different site or when there are significant changes to the current systems or site that have not been agreed to or the Kingfisher Recruitment is not aware of?

  Yes

  No

  N/A

General Work Enviroment

• Yes

  No

  N/A

• Are work areas properly illuminated?

  Yes

  No

  N/A

• Is the ventilation system appropriated for the work performed?

  Yes

  No

  N/A

• Are restrooms and washrooms kept clean and sanitary?

  Yes

  No

  N/A

• Is potable water provided for drinking and washing?

  Yes

  No

  N/A

• Clear and safe access and egress to building/rooms including emergency access and security measures?

  Yes

  No

  N/A

• Where heat stress is a problem, do all fixed work areas have air conditioning?

  Yes

  No

  N/A

• Is the work area clean and orderly?

  Yes

  No

  N/A

• Are floors kept clean and dry or have you taken appropriate measures to make floors slip resistant?

  Yes

  No

  N/A

• Are floors free from protruding nails, splinters, holes, etc.?

  Yes

  No

  N/A

• Are walkways and passageways clearly marked?

  Yes

  No

  N/A

• Are walkways and passageways kept clear?

  Yes

  No

  N/A

• Are pits and floor openings covered or guarded?

  Yes

  No

  N/A

• WHS information (i.e., WHS policy, procedures, posters, emergency contact details) displayed/ accessible on site. Names and photos of Health and Safety Representatives, Fire Wardens and First Aiders displayed in the workplace

  Yes

  No

  N/A

• Are the appropriate fire extinguishers available and in date? Is combustible trash removed from the worksite daily? Is combustible trash removed from the worksite daily?

  Yes

  No

  N/A

• Are spill kits available and in date, are materials or liquids cleaned up immediately?

  Yes

  No

  N/A

• Remote or isolated workers are provided with a system of work that includes effective communication for accessing assistance

  Yes

  No

  N/A

• Outdoor workers have been provided with protection against adverse weather conditions and solar ultraviolet exposure

  Yes

  No

  N/A

• Is there safe delineation and clearance where motorised or mechanical handling equipment travel? (Traffic Management Plan in place?)

  Yes

  No

  N/A

• Are floor openings or penetrations guarded by covers or guardrails on all sides?

  Yes

  No

  N/A

• Are uneven surfaces, steps clearly marked?

  Yes

  No

  N/A

• Are grates or similar type covers over floor openings such as floor drains, designed so that foot traffic or rolling equipment are not affected by grate spacing?

  Yes

  No

  N/A

• Are open-sided floors, platforms and runways having a drop of more than 1.5m guarded by a standard railing or toe board?

  Yes

  No

  N/A

• Are stairs, steps and landings in good condition and clear of obstructions?

  Yes

  No

  N/A

• The layout of the workplace allows, and the workplace is maintained so as to allow, for people to enter and exit and to move about without risk to health and safety, both under normal working conditions and in an emergency

  Yes

  No

  N/A

• A safe system has been implemented for the collection, storage, and disposal of excess or waste materials

  Yes

  No

  N/A

• Sufficient area has been allocated to safely store materials or plant for the construction work

  Yes

  No

  N/A

• Adequate facilities have been provided for workers, including toilets, drinking water, washing facilities, and eating facilities

  Yes

  No

  N/A

• Amenities are maintained in a hygienic, safe, and serviceable condition through a system for inspecting and cleaning the amenities

  Yes

  No

  N/A

• A room or sheltered area to eat meals and take breaks in, is reasonably available to workers and complies with the requirements relating to:

• hygiene

  Yes

  No

  N/A

• separation from work activities that expose or are likely to expose construction workers to a health or safety risk

  Yes

  No

  N/A

• adequate space and seating

  Yes

  No

  N/A

• appropriate facilities for washing and storing utensils, boiling water, and storing food in a cool place

  Yes

  No

  N/A

• Adequate clean water for washing the hands and face supplied through an appropriate facility are reasonably available

  Yes

  No

  N/A

• Where the workplace is located within an existing workplace such as a school or similar facility, there is a plan which specifies how unauthorised access of children and staff will be prevented, including how the host employer will communicate with the school or facility to manage this issue.

• Are all exits marked with an exit sign and illuminated by a reliable light source?

  Yes

  No

  N/A

• Are exit routes clearly marked?

  Yes

  No

  N/A

• Are all exits kept free of obstructions?

  Yes

  No

  N/A

CHEMICAL HAZARDS

• Do you have an inventory of all hazardous substances used in your workplace?

  Yes

  No

  N/A

• Can you provide a list of that inventory in which on-hire workers may be exposed to?

  Yes

  No

  N/A

• Is there a written hazard communication program that covers Material Safety Data Sheets (MSDS), SWMS, labeling and employee training?

  Yes

  No

  N/A

• Can Provide copies of those relevant to the assignment.

  Yes

  No

  N/A

• Is there a MSDS readily available for each hazardous substance used?

  Yes

  No

  N/A

• Is there an employee training program for hazardous substances?

  Yes

  No

  N/A

• An explanation of what a MSDS is and how to use and obtain it?

  Yes

  No

  N/A

• The physical and health hazards of substances in the work area, and specific protective measures to be used?

  Yes

  No

  N/A

• Employee access to the employer’s written hazard communication program and where hazardous substances are present in their work areas? are they stored correctly?

  Yes

  No

  N/A

• An explanation of the appropriate PPE and First aid associated with each chemical?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT (PPE)

• Is personal protective equipment (PPE) provided, used and maintained when required?

  Yes

  No

  N/A

• Are protective, face shields or glasses used where there is a danger of flying particles or corrosive materials splash?

  Yes

  No

  N/A

• Are protective gloves, aprons, shields or other means provided and used to prevent cuts and corrosive liquid or chemical splash injuries?

  Yes

  No

  N/A

• Are hard hats provided and worn where there is a danger of falling objects?

  Yes

  No

  N/A

• Are task specific PPE items provided along with training on use?

  Yes

  No

  N/A

• Are employees trained in the selection, use and maintenance of PPE and protective clothing?

  Yes

  No

  N/A

• Is appropriate foot protection provided and used where there is a risk of foot injuries from hot, corrosive substances or falling objects or crushing or penetrating actions?

  Yes

  No

  N/A

• Why not and how is this managed?

• Is hearing protection provided and use when noise levels exceed 85 dB, HIOSH noise standards?

  Yes

  No

  N/A

• Personal protective equipment (PPE) has been provided to workers where it is prescribed as a control measure

• suitable for the relevant hazards

  Yes

  No

  N/A

• maintained such that it is clean and hygienic and in good working order

  Yes

  No

  N/A

• Workers have been provided with information, training, and instruction on the proper use and wearing of PPE

  Yes

  No

  N/A

• Is respiratory protection provided and used when required?

  Yes

  No

  N/A

• Do you have written procedures for the selection, use and maintenance of respirators?

  Yes

  No

  N/A

• Are employees instructed and trained in the limitations, proper use and care of respirators used?

  Yes

  No

  N/A

• Are users of negative pressure respirators fit tested?

  Yes

  No

  N/A

• Are respirator users given periodic physical examinations?

  Yes

  No

  N/A

ELECTRICAL SAFETY

• Do you specify compliance Standards for all electrical work contacted out to On-Hire workers?

  Yes

  No

  N/A

• Are on-hire workers listed on your insurance policies and included in training?

  Yes

  No

  N/A

• Are employees instructed to make preliminary inspections and tests to determine what conditions exist before starting electrical work?

  Yes

  No

  N/A

• When electrical equipment or lines are serviced, maintained, or adjusted, are necessary switches opened, locked-out when possible and tagged?

  Yes

  No

  N/A

• Are all portable electrical tools and equipment in safe and working order and Tested, Tagged and in date?

  Yes

  No

  N/A

• Do extension cords have insulated stands or hooks?

  Yes

  No

  N/A

• Are RCD, safety switches and lock out systems in place on electrical cabinets and outlets?

  Yes

  No

  N/A

• Do you repair or replace wiring and cords with frayed or deteriorated insulation promptly?

  Yes

  No

  N/A

• In wet or damp locations, are electrical tools and equipment appropriate for use?

  Yes

  No

  N/A

• Do you establish the location of electrical power lines and cables (overhead, underground, other side of walls, etc.) before digging, drilling, demolition or other similar work begins

  Yes

  No

  N/A

• Do you prohibit the use of metal ladders in areas where the ladder or person using the ladder could come in contact with energised parts of equipment or circuit conductors?

  Yes

  No

  N/A

• Are all disconnecting switches and circuit breakers labeled to indicate their use or the equipment they serve?

  Yes

  No

  N/A

• How is this managed and the risk of electrocution eliminated?

• Do you disconnect electrical circuits before commencing any works?

  Yes

  No

  N/A

• Why would a worker be working on a live circuit? (explain in detail and include controls)

• Are all energised parts of electrical circuits and equipment guarded by approved cabinets or enclosures against accidental contact?

  Yes

  No

  N/A

• Do you maintain sufficient access and working space around all electrical equipment to permit ready and safe operation and maintenance?

  Yes

  No

  N/A

• Are employees who regularly work on or around energised electrical equipment or lines instructed in cardiopulmonary resuscitation (CPR) and High and Low power rescue?

  Yes

  No

  N/A

• Are employees prohibited from working alone on energised lines or equipment?

  Yes

  No

  N/A

HAZARDOUS MATERIAL AND CHEMICAL WORKS & EXPOSURE

• This section is only relevant if the on-hire worker will be performing high risk works associated with hazardous materials and chemicals. (IF YOU IDENTIFY THIS SECTION IS REQUIRED KF MANAGMENT NEED TO BE CONTACTED IMMEDATELY - THIS IS A HOLD POINT)

• Are employees provided training and qualifications in safe handling practices of hazardous chemicals such as acids, bases, caustics, epoxies, phenols, etc.?

  Yes

  No

  N/A

• Is employee exposure to chemicals within acceptable levels?

  Yes

  No

  N/A

• Are eye wash fountains and showers provided where hazardous chemicals are handled?

  Yes

  No

  N/A

• Are employees required to use personal protective equipment when handling chemicals (gloves, aprons, boots, eye and face protection, respirators, etc.) and are these provide with training on use and maintenance?

  Yes

  No

  N/A

• Are chemical piping systems marked as to their content?

  Yes

  No

  N/A

• Are all containers such as vats, storage tanks, etc., labeled as to their contents (e.g., “CAUSTICS”) and stored correctly?

  Yes

  No

  N/A

• Have written standard operating procedures been published for handling chemicals and are they being followed?

  Yes

  No

  N/A

• Do employees complain about dizziness, headache, nausea, irritation, or others discomfort factors when they use chemicals?

  Yes

  No

  N/A

• Is there a dermatitis problem (e.g., employees complain about dryness, irritation, or sensitization of the skin)?

  Yes

  No

  N/A

• Have control measures been instituted for hazardous materials such as exhaust ventilation systems, handling procedures and personal protective equipment?

  Yes

  No

  N/A

• Is vacuuming used, rather than blowing or sweeping dust whenever possible? Is silica awareness and controls in place?

  Yes

  No

  N/A

• Has any asbestos been identified on site? If so, what controls are in place, and can you provide a copy of the register

  Yes

  No

  N/A

• Workers involved in asbestos removal work or in the carrying out of asbestos-related work have been trained in the identification of and safe handling of asbestos and ACM

  Yes

  No

  N/A

• A SWMS is available for all work that involves or is likely to involve the disturbance of asbestos, silica products or MDF that has commenced or is about to commence

  Yes

  No

  N/A

• Are spill kits available in date and in locations that are easily accessible?

  Yes

  No

  N/A

• Have written standard operating procedures been established and are they followed for chemical spill cleanup?

  Yes

  No

  N/A

CONFINED SPACE

• Is a Confined Space Entry Permit, rescue plan, risk assessment, SWMS and Gas Monitoring report signed by the entry supervisor, provided prior to any permit required confined space works?

  Yes

  No

  N/A

• Are confined spaces thoroughly emptied of any corrosive or hazardous substances (acids or caustics) before entry?

  Yes

  No

  N/A

• Are all lines to a confined space containing inert, toxic, flammable or corrosive materials, shut off and blanked, disconnected or separated before entry?

  Yes

  No

  N/A

• Is it required that impellers, agitators or other moving equipment inside confined spaces be locked-out and tagged before entry?

  Yes

  No

  N/A

• Is exhaust ventilation required before confined space entry?

  Yes

  No

  N/A

• Are gas tests performed for oxygen deficiency, toxic substances and explosive concentrations before confined space entry?

  Yes

  No

  N/A

• Is there adequate illumination for confined space work?

  Yes

  No

  N/A

• Is the atmosphere inside the confined space periodically tested or continuously monitored during the conduct of work?

  Yes

  No

  N/A

• Is there an assigned safety standby (rescue) employee outside of the confined space, when required, whose sole responsibility is to watch the work in progress, sound an alarm and render assistance if necessary?

  Yes

  No

  N/A

• Is the standby employee trained and equipped to handle an emergency?

  Yes

  No

  N/A

• Is the standby employee prohibited from entering the confined space in an emergency unless relieved by a qualified safety standby and equipped with lifelines and respiratory equipment?

  Yes

  No

  N/A

• Is communication provided between the standby employee and confined space entrants, as well as emergency rescue personnel?

  Yes

  No

  N/A

• Is self-rescue equipment provided? And adequate safety checks performed on equipment, including practice emergency rescue drills and training?

  Yes

  No

  N/A

• Is specific safety equipment and clothing provided when required?

  Yes

  No

  N/A

• Are workers qualifications, licensing and competency verified onsite and a specific task induction and brief conducted?

  Yes

  No

  N/A

• Before gas welding or cutting is started in a confined space, are hoses checked for leaks, compressed gas cylinders forbidden in the confined space, torches lighted outside the confined space, and is the confined area tested for toxic and combustible gases?

  Yes

  No

  N/A

• The entry and exit openings of all confined spaces are large enough to allow emergency access and are not obstructed

  Yes

  No

  N/A

• Unauthorised entry into confined spaces has been prevented using locks, fixed barriers, or other security devices

  Yes

  No

  N/A

• Workers required to work in or around a confined space have been provided with information, instruction, and training in relation to the:

  Yes

  No

  N/A

FIRE SAFETY

• If you have an alarm system, is it tested annually?

  Yes

  No

  N/A

• Are on-hire candidates inducted trained on fire emergency plan?

  Yes

  No

  N/A

• Are fire doors operating properly and unobstructed?

  Yes

  No

  N/A

• Are fire extinguishers provided in adequate number and type and checked regularly and in date?

  Yes

  No

  N/A

• Date of Inspection:

  Date

• Are fire extinguishers serviceable and mounted in readily accessible locations?

  Yes

  No

  N/A

• Are employees instructed in the use of fire extinguishers and types for specific tasks?

  Yes

  No

  N/A

• Is access to fire extinguishers and hose reels free of obstruction?

  Yes

  No

  N/A

• Are fire extinguishers selected and provided for the class(es) of fires expected based on materials stored in the area?

  Yes

  No

  N/A

• Class A: Ordinary combustible material fires

  Yes

  No

  N/A

• Class B: Flammable liquid, gas or grease fires

  Yes

  No

  N/A

• Class C: Energized – electrical equipment fires

  Yes

  No

  N/A

• Class D: Fire in combustible metals

  Yes

  No

  N/A

• Are approved containers and tanks used for the storage and handling of flammable and combustible liquids, and are they stored in appropriate locations and access is restricted?

  Yes

  No

  N/A

• Is petrol and diesel stored, handled and used in accordance with safe practices and standards?

  Yes

  No

  N/A

• Are “NO SMOKING” NO NAKED FLAMES” signs posted on petrol and diesel storage tanks and locations?

  Yes

  No

  N/A

• Are “NO SMOKING” NO NAKED FLAMES signs posted in areas where flammable or combustible materials are used or stored?

  Yes

  No

  N/A

• Are “NO SMOKING” NO NAKED FLAMES rules enforced in areas where flammable or combustible materials are used or stored?

  Yes

  No

  N/A

• Are all solvents and flammable wastes kept in fire resistant, covered containers and promptly removed from the worksite?

  Yes

  No

  N/A

LOCKOUT AND TAG OUT FOR MAINTENANCE

• Is all equipment capable of movement deenergised or disengaged, and blocked or locked-out during cleaning, servicing, adjusting, or setting up operations?

  Yes

  No

  N/A

• Does the lockout procedure require that stored energy (mechanical, hydraulic, air, etc.) be released or blocked before equipment is locked out for repairs?

  Yes

  No

  N/A

• Is the employee exposed to the hazard the only one who can place or remove the safety lock?

• Or is a permit officer and controller? Can you share the permit procedure

  Yes

  No

  N/A

• Do employees check the safety of the lockout by attempting to start up the machine after making sure no one else is exposed?

  Yes

  No

  N/A

• Are employees instructed to always push the control circuit stop button prior to re-energizing the main power switch, or turning the plant or equipment on?

  Yes

  No

  N/A

• In the event that the equipment cannot be shut down and locked-out, has a safe tag-out procedure been established and rigidly followed?

  Yes

  No

  N/A

• Date Of Inspection:

  Date

SCAFFOLDING

• Scaffolding has been erected by appropriately licensed workers

  Yes

  No

  N/A

• Scaffolding is or has been erected and/or dismantled so as to eliminate or minimise the risk of falling at least 3m, in housing construction, or 2m in all other construction to people carrying out the work, in accordance with the regulations

  Yes

  No

  N/A

• Safe access to and egress from scaffold has been provided during erection, use, and dismantling

  Yes

  No

  N/A

• Written confirmation from a competent person stating that the construction of a particular scaffold has been completed, has been obtained prior to the use of that particular scaffold

  Yes

  No

  N/A

• Each scaffold and its supporting structure has been inspected by a competent person:

  Yes

  No

  N/A

• Scaffold or supporting structures that have been identified by an inspection as creating a risk to health and safety are repaired, altered, and added to as necessary, and inspected again by a competent person prior to use

  Yes

  No

  N/A

• Each scaffold has been erected, used, and dismantled in accordance with the:

• scaffold plan

  Yes

  No

  N/A

• manufacturer’s instructions and specifications

  Yes

  No

  N/A

• Scaffolding Code of Practice 2009

  Yes

  No

  N/A

• AS/NZS 1576:2010 Scaffolding

  Yes

  No

  N/A

• Are “DO NOT ALTER SCAFFOLD” signs placed around scaffolding?

  Yes

  No

  N/A

• Are physical barriers in place to prevent plant or vehicle contact?

  Yes

  No

  N/A

• Are working levels fully planked between guardrails?

  Yes

  No

  N/A

• Have personnel been instructed in scaffold safety?

  Yes

  No

  N/A

NOTE: Anyone constructing, or directly supervising the workers constructing any scaffold from which a person or materials could fall more than 4 meters (including mobile scaffolds), must have a current high risk work license or equivalent certificate of competency appropriate to that type of scaffold

NOISE

• Are there areas in the workplace where continuous noise levels exceed 85 decibels (dBA)?

  Yes

  No

  N/A

• Have engineering controls been used to reduce excessive noise levels?

  Yes

  No

  N/A

• Where engineering controls are determined to be unfeasible, have administrative controls (i.e., worker rotation) been instituted to minimise individual employee exposure to noise?

• Is approved hearing protective equipment (noise attenuating devices) available to all employees working in noisy areas and has training been provided?

  Yes

  No

  N/A

• Have you isolated noisy equipment from the rest of your operation?

  Yes

  No

  N/A

• If you use ear protectors, are employees properly instructed in their proper use?

  Yes

  No

  N/A

• Are employees in high noise areas given periodic audiometric testing to ensure that you have an effective hearing protection program?

  Yes

  No

  N/A

• Workers must not be exposed to over 85 decibels (as an average) over eight hours at work. Machines like blenders, lawnmowers and leaf blowers are around 85 decibels. This rule changes depending on decibels and time exposed. For example, the risk at 91 decibels over two hours is the same as 85 decibels over eight hours

  Compliant

  Non-Compliant

  N/A

• You must also provide audiometric testing for workers who you require to frequently wear personal hearing protection for their work

  Compliant

  Non-Compliant

  N/A

HAND AND POWER TOOLS

• Are tools and equipment (Candidate & Host Employer) in good condition?

  Yes

  No

  N/A

• Is eye and face protection worn while using hand tools that might produce flying materials or breakage?

  Yes

  No

  N/A

• Have employees been trained to use hand tools properly?

  Yes

  No

  N/A

• Are jacks checked to assure they are in good operating condition and marked with the jack capacity?

  Yes

  No

  N/A

• Are grinders, saws and similar equipment used with appropriate safety guards, correct blades and tested tagged and well maintained?

  Yes

  No

  N/A

• Are portable circular saws equipped with guards above and below the base shoe?

  Yes

  No

  N/A

• Are rotating or moving parts guarded to prevent physical contact?

  Yes

  No

  N/A

• Are all cord-connected, electrically operated tools and equipment tested and tagged?

  Yes

  No

  N/A

• Are guards in placed over belts, pulleys, chains and sprockets on equipment such as concrete mixers, air compressors, etc.?

  Yes

  No

  N/A

• Are RCDs used with portable electrical power tools?

  Yes

  No

  N/A

• Are pneumatic and hydraulic hoses on power-operated tools inspected regularly for serviceability?

  Yes

  No

  N/A

• Do chain saws have anti-kickback devices, and are chaps and face shields provided?

  Yes

  No

  N/A

• Are tools (i.e. nail gun, framing gun) in good working order?

  Yes

  No

  N/A

• Are employees prohibited from using explosive tools if they are not formally qualified and trained to do so?

  Yes

  No

  N/A

• Are the correct charges used and are these inspected regularly?

  Yes

  No

  N/A

• Are goggles or face shields and hearing protection always worn while using explosive power tools?

  Yes

  No

  N/A

• Are dust collectors or powered exhausts provided?

  Yes

  No

  N/A

• Are employees who operate power-actuated or explosive tools trained in their use and do they carry a valid license or verification of competency?

  Yes

  No

  N/A

• Is each power-actuated and explosive tool stored in its own locked container when not being used?

  Yes

  No

  N/A

• Is a sign at least “POWER ACTUATED TOOL IN USE” conspicuously placed to warn others that the tool is being used?

  Yes

  No

  N/A

• Are power-actuated tools left unloaded until they are ready to be used?

  Yes

  No

  N/A

• Are power actuated tools inspected for obstructions or defects each day before use?

  Yes

  No

  N/A

• Do power actuated tool operators have and use appropriate personal protective equipment (head, eye, hearing, etc.)?

  Yes

  No

  N/A

CIVIL CONSTRUCTION

• Are rollover protection structures (ROPS) provided for civil plant and equipment including but not limited to: scrapers, front-end loaders, bulldozers, wheel-type industrial tractors, crawler tractors and motor graders?

  Yes

  No

  N/A

• Are backup alarms and beacons installed?

  Yes

  No

  N/A

• How do you ensure reversing vehicles are noticed?

  Yes

  No

  N/A

• Are operators licensed and do they have proper medical clearances?

  Yes

  No

  N/A

• Has the plant and equipment pre-operation checklist been completed by the operator prior to operations?

  Yes

  No

  N/A

• Has plant been inducted and tested periodically and have services logs?

  Yes

  No

  N/A

• EXCAVATING AND TRENCHING

• For trenches 1.5m or more deep, the sides of the trench have been adequately supported by one of the following:

  Yes

  No

  N/A

• shoring by shielding or other comparable means

  Yes

  No

  N/A

• benching

  Yes

  No

  N/A

• battering

  Yes

  No

  N/A

• For trenches 1.5m or more deep, the work area has been, so far as is reasonably practicable, secured from unauthorised access, including inadvertent entry

  Yes

  No

  N/A

• Is excavated material placed 1meter or more from the edge of the excavation?

  Yes

  No

  N/A

• Is heavy equipment kept a safe distance from the edge of the excavation to prevent cave-in?

  Yes

  No

  N/A

• Is the ladder provided for exiting the trench located within 3 meters of those working in the trench?

  Yes

  No

  N/A

• Are signs, barricades and spotters used to warn other workers, pedestrians, motorist when excavating or trenching work is done in shared work areas public spaces or roadways?

  Yes

  No

  N/A

• Do workers in the vicinity of roadways use safety vests for visibility and are traffic controls in place?

  Yes

  No

  N/A

• Are tools such as shovels, picks, hammers, etc. kept away from the edge of trenches to prevent injury to those working in the trench?

  Yes

  No

  N/A

• A SWMS is available for all work that has commenced or is about to commence that involves work on or near:

• pressurised gas distribution mains or piping

  Yes

  No

  N/A

• chemical, fuel, or refrigerate lines

  Yes

  No

  N/A

• energised electrical installations or services

  Yes

  No

  N/A

• The risks to health and safety associated with any excavation work have been identified and managed, including the risk of a person:

• falling into the excavation

  Yes

  No

  N/A

• being trapped by the collapse of an excavation

  Yes

  No

  N/A

• working in an excavation being struck by a falling object

  Yes

  No

  N/A

• working in an excavation being exposed to an airborne contaminant

  Yes

  No

  N/A

• Are DBYD plans and the appropriate service location efforts made and permits to penetrate in place and signed off prior to excavations being carried out, and are qualified spotters or asset owners in attendance as required? (i.e. HV spotter, Gas Spotter) Workers carrying out excavation work have been provided with the current underground essential services information

  Yes

  No

  N/A

Ladder Safety

• Are all ladders maintained in good condition?

  Yes

  No

  N/A

• Is each ladder equipped with non-slip safety feet?

  Yes

  No

  N/A

• Are ladder rungs and steps free of grease and oil?

  Yes

  No

  N/A

• Are ladders prohibited from being placed on unstable bases (such as boxes, barrels, truck beds, etc.) to gain added height?

  Yes

  No

  N/A

• Do employees face the ladder and use both hands when climbing and descending the ladder?

  Yes

  No

  N/A

• Are unserviceable ladders discarded?

  Yes

  No

  N/A

• Do ladders extend at least 3 feet above the landing?

  Yes

  No

  N/A

• Are rungs of ladders uniformly spaced?

  Yes

  No

  N/A

• Do employees stand on the top step of ladders?

  Yes

  No

  N/A

• Ladders are used only for the purpose for which they have been designed

  Yes

  No

  N/A

• Single or extension ladders are only used at the appropriate angle, as per the regulations

  Yes

  No

  N/A

• Are portable metal ladders marked with signs reading, “CAUTION – DO NOT USE AROUND ELECTRICAL EQUIPMENT?”

  Yes

  No

  N/A

• Single or extension ladders are only used to gain access to a place (i.e. not to perform construction, or maintenance works)

  Yes

  No

  N/A

VEHICLE USE

• Are vehicles equipped with all safety items including UHF radio, flashing lights, reverse beeper, cameras?

  Yes

  No

  N/A

• Are on-hire employees inducted and trained on the specific requirements and policies in place for vehicle operation, and are they listed on your insurance policies?

  Yes

  No

  N/A

• Are vehicles used maintained and are service records and pre-start checklist available?

  Yes

  No

  N/A

• Are vehicles equipped with lamps, brakes, horns, mirrors, windshields and turn signals in good operating condition?

  Yes

  No

  N/A

• Are vehicles equipped with breakdown equipment?

  Yes

  No

  N/A

• Is a fully charged and serviceable fire extinguisher, at least 4 B:C rating maintained in each vehicle?

  Yes

  No

  N/A

• When cutting tools or tools with sharp edges are carried in passenger compartments of vehicles, are they place in closed boxes or containers secured in place?

• Are employees trained on the correct methods in securing loads and have the appropriate tools equipment to do so?

  Yes

  No

  N/A

• Is there a driver record kept or are vehicles fitted with GPS and FOB access?

  Yes

  No

  N/A

FIXED PLANT AND MACHINERY

• Yes

  No

  N/A

• Is there a training program to instruct employees on safe methods of machine operation, and are SOP in place and easily accessible for review?

  Yes

  No

  N/A

• Is there a regular safety inspection program for equipment?

  Yes

  No

  N/A

• Do you clean and properly maintain machinery and equipment?

  Yes

  No

  N/A

• Is adequate space provided around and between equipment to permit set-up, servicing, material handling and waste removal?

  Yes

  No

  N/A

• Is equipment anchored to prevent tipping or movement?

  Yes

  No

  N/A

• Is there a power shutoff switch within reach of the operator’s position for each machine?

  Yes

  No

  N/A

• Are all emergency stop buttons colored red?

  Yes

  No

  N/A

• Can power to each machine be locked-out for maintenance, repair or security purposes?

  Yes

  No

  N/A

• Are foot operated switches guarded to prevent accidental activation by personnel or falling objects?

  Yes

  No

  N/A

• Are pulleys and belts that are within 2.5m of the floor or working level properly guarded?

  Yes

  No

  N/A

• Are moving chains and gears properly guarded?

  Yes

  No

  N/A

• Are machines guarded to protect the operator and other employees in the area from ingoing nip points, rotating parts, flying chips and sparks and other hazards created at the point of operation?

  Yes

  No

  N/A

• Are provisions made to prevent machines from automatically starting when power is restored after a power failure or shutdown?

  Yes

  No

  N/A

• Are fan blades protected with a guard?

  Yes

  No

  N/A

• Are saws used for ripping, equipped with anti-kickback devices and spreaders?

  Yes

  No

  N/A

• Are radial arm saws arranged so that the cutting head will gently return to the back of the table when released?

  Yes

  No

  N/A

• Is eye and hearing protection used when operating machines?

  Yes

  No

  N/A

WORKING AT HEIGHTS

• A SWMS is available for all high risk construction work that involves a risk of a person falling more than 2m that has commenced or is about to commence

  Yes

  No

  N/A

• Where a risk of fall of less than 2m on a specific task or site or on roof with slope not over 26° exists:

• each hazard that may result in a fall or cause death or injury if a person were to fall has been identified

  Yes

  No

  N/A

• the risk of death or injury that may result because of the hazard has been assessed

  Yes

  No

  N/A

• any control measures necessary to prevent, or minimise the level of, exposure to the risk is used

  Yes

  No

  N/A

• Where a risk of fall of at least 2m on a specific task or site or work on roof with a slope over 26° exists, control measures have been used which:

• prevent a person falling any distance

  Yes

  No

  N/A

• if prevention is not practicable:

• arrest a person’s fall

  Yes

  No

  N/A

• prevent or minimise the risk of death or injury to a person when the fall is arrested

  Yes

  No

  N/A

• Examples of control measures to prevent a person falling include:

• edge protection

  Yes

  No

  N/A

• a fall protection cover placed over an opening

  Yes

  No

  N/A

• a travel restraint system

  Yes

  No

  N/A

• a fall arresting platform

  Yes

  No

  N/A

• a fall-arrest harness system

  Yes

  No

  N/A

• an industrial safety net

  Yes

  No

  N/A

• Edge Protection: Edge protection has been erected and is used in accordance with the instructions of:

• the manufacturer or the supplier, where they have been provided, or

  Yes

  No

  N/A

• an engineer or competent person

  Yes

  No

  N/A

• Fall Protection Covers: Each fall protection cover is able to withstand the impact of a fall onto it of any person who may reasonably be expected to fall onto it. Each fall protection cover is securely fixed in place to prevent it being moved or removed accidentally?

  Yes

  No

  N/A

• Fall Arrest Platforms: Each fall arrest platform is able to withstand the impact of any person who may reasonably be expected to fall onto it

  Yes

  No

  N/A

• Harness Systems: Each anchorage point of a fall arrest harness system has been:

• designed by an engineer for that purpose

  Yes

  No

  N/A

• inspected and approved by a competent person prior to that point’s first use by any person

  Yes

  No

  N/A

• Each fall arrest harness system’s device to absorb the energy of a falling person limits the force applied to the persons by a fall to not more than 6kN

  Yes

  No

  N/A

• Sufficient distance is available for a person using the system to fall to prevent the person hitting an object, the ground, or another surface other than a vertical surface

  Yes

  No

  N/A

• No part of a fall arrest harness system can come into contact with anything that could affect the safe use of the system

  Yes

  No

  N/A

• People using fall arrest harness system have been trained in the safe and correct use of the system

  Yes

  No

  N/A

• FALLING OBJECTS AND PUBLIC PROTECTION

• Hoarding that has been used as a control measure:

• will prevent any object that may reasonably be expected to hit it from entering the adjoining area

• is strong enough, and appropriately designed and erected, for the circumstances in which it is used, including the location of the workplace and the type of work to be carried out near the hoarding

  Yes

  No

  N/A

• Perimeter containment screening that has been used as a control measure:

• is made of mesh, timber, plywood or metal sheeting

  Yes

  No

  N/A

• has a gap of no more than 25mm between:

• screens immediately next to each other

  Yes

  No

  N/A

• a screen and the framework supporting it

  Yes

  No

  N/A

• has a supporting framework that is able to bear the load of the screen

  Yes

  No

  N/A

• Where catch platforms that are used or are to be used as a control measure are installed, extended, or reduced, controls have been implemented to prevent a component of the platform falling on people while the platform is installed, extended, or reduced

• Written approval has been obtained from the relevant authority for the closure of any area

• Exclusion zones established and spotters in place to provide safe direction and passage?

  Yes

  No

  N/A

WELDING AND HOT WORK OPERATIONS

• Workers are not exposed to welding fumes that contain a substance or mixture in an airborne concentration that exceeds the exposure standard for the substance or mixture

  Yes

  No

  N/A

• Non-flammable screens or partitions have been installed where appropriate

  Yes

  No

  N/A

• Signs have been erected to warn workers and passers-by that welding is occurring and that entry into the work area is not permitted unless PPE is worn

  Yes

  No

  N/A

• Appropriate PPE has been provided for and is being used by workers performing welding work i.e. filter shades for goggles and face shields to protect the eyes from radiation, gloves and other protective clothing to cover exposed skin

  Yes

  No

  N/A

• The risk of electric shock from contact with the electrode, live parts, the work piece, or through contact with an unearthed cable, lead, or tool has been controlled

  Yes

  No

  N/A

• Welding equipment is used with earth leakage current protection by means of a residual current device

  Yes

  No

  N/A

• Risks to workers from equipment that generates strong electromagnetic fields have been identified and controlled

  Yes

  No

  N/A

• All sources of ignition have been identified and isolated from fuel sources

  Yes

  No

  N/A

• Fire fighting equipment is located near the welding work area

  Yes

  No

  N/A

• Workers are isolated from contacting hot work pieces and otherwise protected from burns and exposure to heat

  Yes

  No

  N/A

• Compressed and liquefied gas cylinders are stored and handled in accordance with regulations

  Yes

  No

  N/A

• Do you periodically check the grounding of the machine frame and safety ground connections of portable machines?

  Yes

  No

  N/A

• Is the welder prohibited from coiling the electrode cable around his body?

  Yes

  No

  N/A

• Cylinders are stored in an upright position and have been secured to prevent dislodgement

  Yes

  No

  N/A

• Flashback arrestors on hoses have been installed and have been tested at intervals of at least every 12 months

  Yes

  No

  N/A

• Cylinder valves are closed when the cylinder is not being used, Cylinders have been fitted with a bursting disc safety device or an operational spring-loaded pressure relief valve as appropriate. Cylinder fittings, hoses, and connections are not damaged or in poor condition

  Yes

  No

  N/A

• Are firewatchers assigned when welding or cutting is done in locations where a serious fire may occur?

  Yes

  No

  N/A

• When floors are wet, are personnel protected from possible electrical shock?

• When welding or cutting is done on walls, are precautions taken to protect combustibles on the other side?

• Are employees who are exposed to the hazards of welding, cutting or brazing protected with personal protective equipment?

  Yes

  No

  N/A

• Is a check made for adequate ventilation when welding or cutting is done?

  Yes

  No

  N/A

• When working in confined spaces, are tests for toxic and combustible gases taken prior to welding, cutting or brazing?

PAINTING OPERATIONS

• Do you have adequate ventilation before any painting operations begin?

  Yes

  No

  N/A

• Is the area kept clean of combustible residue?

  Yes

  No

  N/A

• Is mechanical exhaust ventilation provided when painting operations are conducted in enclosed areas?

  Yes

  No

  N/A

• If spraying is the spray area at least 20 feet from flames, sparks, electrical motors, and other ignition sources?

  Yes

  No

  N/A

• Is approved respiratory equipment provided and used during spraying operations and all other relevant PPE?

  Yes

  No

  N/A

• Are “NO SMOKING””NO OPEN FLAMES” signs posted in spray areas, paint rooms, paint booths and paint storage areas?

  Yes

  No

  N/A

• Are spray booths constructed of noncombustible material?

  Yes

  No

  N/A

• Are electric motors for exhaust fans placed outside spray booths?

  Yes

  No

  N/A

• Are MSDS and spill kits available and nearby, are employees trained on how to use them in the event of a spill or incident?

  Yes

  No

  N/A

FORKLIFTS< INDUSTRIAL TRUCKS AND OTHER MOBILE PLANT

• Are only trained personnel allowed to operate and forklift industrial trucks? (high risk work license and verification of competency)?

  Yes

  No

  N/A

• Is overhead protection provided on high reach lift trucks?

  Yes

  No

  N/A

• Does each industrial truck have a warning device that can be clearly heard above the normal noise in the operating area?

  Yes

  No

  N/A

• Are lift truck operating rules posted and enforced, including right of way and dedicated and marked operating areas?

  Yes

  No

  N/A

• Are brakes on industrial trucks capable of bringing the vehicle to a complete and safe stop when fully loaded?

  Yes

  No

  N/A

• Will the industrial truck’s parking brake prevent the vehicle from moving when unattended?

  Yes

  No

  N/A

• Are forklift loads lowered while the truck is traveling?

  Yes

  No

  N/A

• Are industrial trucks operating in areas where flammable gases or vapors, or combustible dust or ignitable fibers may be present in the atmosphere, approved for such locations?

  Yes

  No

  N/A

• Are motorised hand and hand/rider trucks designed so when the brakes are applied, power to the drive motor shut off when the operator releases his grip on the device that controls the travel?

  Yes

  No

  N/A

• The risks to health and safety associated with any plant at the workplace have been identified and managed. Unauthorised alterations or interference with the plant has been prevented

  Yes

  No

  N/A

• Plant is used only for the purpose for which it has been designed or otherwise in a way that does not increase the risk to health and safety

  Yes

  No

  N/A

• Health and safety features and warning devices, are operational and are used in accordance with the relevant instructions and information. Examples include:

• guarding

  Yes

  No

  N/A

• operational controls

  Yes

  No

  N/A

• emergency stops

  Yes

  No

  N/A

• other warning devices

  Yes

  No

  N/A

• Plant that is not in use has been left in a state that does not create a risk to the health and safety of any person

  Yes

  No

  N/A

• The host employer has managed the risks to health and safety associated with the storage of workplace plant that is not in use

  Yes

  No

  N/A

• Maintenance, inspection, and testing is carried out by a competent person

  Yes

  No

  N/A

• Maintenance, inspection, and testing is carried out:

• in accordance with the manufacturer’s recommendations

  Yes

  No

  N/A

• where there are no manufacturer’s recommendations, in accordance with the recommendations of a competent person

• Assess risks associated with:

• plant overturning

  Yes

  No

  N/A

• things falling on the operator

  Yes

  No

  N/A

• the operator being ejected

  Yes

  No

  N/A

• the plant colliding with any person or thing

  Yes

  No

  N/A

• mechanical failure of pressurised elements of the plant that may release fluids that pose a risk to health and safety have been identified and managed

  Yes

  No

  N/A

• A SWMS is available for work that includes the use of powered mobile plant that has commenced or is about to commence

  Yes

  No

  N/A

• Mobile plant operators hold the appropriate high risk work licence or, for earthmoving equipment and particular cranes, have been deemed competent

  Yes

  No

  N/A

• People other than the operator of an item of mobile plant are prevented from riding on the plant or are otherwise provided with a level of protection that is equivalent to that provided to the operator

  Yes

  No

  N/A

• Industrial lift trucks are not used to carry passengers unless the:

• truck is designed to carry a seated passenger

  Yes

  No

  N/A

• passenger seat is fitted with suitable restraints

  Yes

  No

  N/A

• passenger seat is located within the zone of protection that is provided by the operator protective device

  Yes

  No

  N/A

• Are industrial trucks or plant with internal combustion engines, operating in buildings or enclosed areas, carefully checked to ensure such operations do not cause harmful concentrations of dangerous gases or fumes?

  Yes

  No

  N/A

• List any additional hazards how they will be Rectified Managed and Controlled. This should include the person responsible and the date required.

• Assesment: