Information

  • Site conducted

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Employee name:

  • Staff number:

  • Manager:

  • Designation:

  • Location:

1.0 Personal Protective Equipment

  • Guideline: Minimum site safety requirements. Specific machinery / tooling requirements and any additional items identified in the Job Plan are in use (e.g. hi-visibility jacket worn in rail corridor, ankle to elbow cover, steel top capped above ankle lace up boots, eye protection, hard hat (where applicable and within certification date).

  • Boots

  • Gloves

  • Earmuffs

  • Hard hat

  • Safety glasses

  • Hi-visibility

  • Full body cover

  • Spats

  • Chaps

  • Hot gloves

  • Sun hat

  • Sun screen

  • Harness

  • Lanyard

  • Pole strap

  • Rail puppy

  • Climbing helmet

  • Head light

  • Helmet issue date:

  • General comments

  • Add media

2.0 Protection Applied

  • Current daily information bulletin sighted. Communications plan recorded (where required). Protection obtained (including all tracks fouled).

  • General comments

  • Add media

3.0 Pre-start safety briefing / job plans

  • Briefing conducted for all personnel on site. Briefing included contractors and visitors. Evidence of briefing and signatures.

  • General comments

  • Add media

4.0 Hazard identification

  • Evidence of hazards being identified, communicated and effectively controlled. Confirm compliance with Job Plans.

  • General comments

  • Add media

5.0 Hazardous materials

  • Up to date Safety Data Sheets are available for hazardous products being used on site. Confirm staff understanding of controls necessary (e.g. personal protective equipment, first aid requirements, environmental issues, product reactivity).

  • General comments

  • Add media

6.0 Housekeeping and the environment

  • Worksite is clear of trip hazards. Waste is collected and and disposed of appropriately. Environmental impacts have been considered before and during tasks performed. Appropriate spill kits are available (if required).

  • General comments

  • Add media

7.0 Adequate facilities

  • Guideline: Potable water is available? Adequate shelter? Hand washing facilities?

  • Potable water?

  • Adequate shelter?

  • Hand wipes?

  • General comments

  • Add media

8.0 Manual handling

  • Good manual handling practices observed?

  • General comments

  • Add media

9.0 Incident reporting

  • Guideline: Staff understand how to report incident both verbally and written?

  • Staff understand the incident reporting process?

  • General comments

10. 0 Emergency planning

  • Emergency plans are available and emergency assembly areas have been identified and communicated to staff?

  • General comments

  • Add media

11.0 Plant and equipment

  • Correct plant being used for the task?

  • Plant certified safe for use?

  • Danger tags in use?

  • General comments

  • Add media

SITE SPECIFIC CRITERIA

12.0 Electrified areas (AC and DC)

  • Minimum approach distances (MAD) understood and followed for people and plant?

  • Permit to work issued?

  • Approved tools / methods used in electrified areas?

  • undefined

  • Add media

13.0 Contractor management (Supervisor only)

  • All contractors have been inducted?

  • Contractors are adequately supervised by Network employees?

  • undefined

14.0 Working at height

  • Height safety equipment registered and certified?

  • Adequate protection provided for staff working at height?

  • "Work Safe" notification procedure for working at height understood?

  • undefined

  • Add media

15.0 Working in tunnels

  • Gas monitors in use?

  • Gas detectors within calibration period?

  • Gas monitors "bump tested" before use?

  • Gas masks and emergency rescue equipment available?

  • Confined space permit issued?

  • Staff understand required response and evacuation procedures if gas alarm or warning sounds?

  • undefined

  • Add media

16.0 Lone worker

  • Lone worker process understood and used

17.0 Traffic management plan

  • Staff understand when a traffic management plan is required?

  • Plans are available (if applicable)?

  • Adequate equipment available to implement the traffic management plan?

  • Site Traffic Management Supervisor (STMS) identified and qualified?

  • undefined

  • Add media

18.0 Corrective actions

  • undefined

  • Add signature

  • Observee:

  • HSE Coordinator:

  • Select date

  • Forward completed and signed copy to KiwiRail's Training Team to record in the Training Database.

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.