KZK-SHC-INSPECTION

• Document No.

• Type of document

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Worksite inspection

• Type of work

• Site location
  Address

• Date and time

  Date

Site access

• Complete permit to work form

  Yes

  No

  N/A

• Worker have valid NTMSP

  Yes

  No

  N/A

• Worker have valid AESP and AGTES card

  Yes

  No

  N/A

General safety requirement at site

• Toolbox briefing before work

  Yes

  No

  N/A

• All worker wear personal protective equipment (PPE)

  Yes

  No

  N/A

Emergency preparedness and hygiene

• Fire extinguisher present

  Yes

  No

  N/A

• First aid present

  Yes

  No

  N/A

• Clean water and other hygiene tools

  Yes

  No

  N/A

Confine space entry

• Confine space permit to work

  Yes

  No

  N/A

• Atmosphere testing before entry

  Yes

  No

  N/A

• Safe continuous ventilation

  Yes

  No

  N/A

• Isolating manhole (barricade)

  Yes

  No

  N/A

• Communication between authorise entrant and stanby person

  Yes

  No

  N/A

• 'Warning confine space' signage present

  Yes

  No

  N/A

Working at height

• 10 feet above ground worker wear harness

  Yes

  No

  N/A

• Ladder in good condition

  Yes

  No

  N/A

• Ladder secured for working

  Yes

  No

  N/A

• Buddy system working on ladder

  Yes

  No

  N/A

Trenching and excavating work

• Tool and equipment place 1 meter from hole

  Yes

  No

  N/A

• 1.2 meter above use ladder used for ingress

  Yes

  No

  N/A

• 1.5 meter above shoring installation with PE endorse present

  Yes

  No

  N/A

• No heavy machinery activity near

  Yes

  No

  N/A

Working near power line

• Clearing area 3 meter from power line

  Yes

  No

  N/A

• Supervision,signalman,flagman etc.

  Yes

  No

  N/A

• Weather suitable for work (not raining, thunder and moist)

  Yes

  No

  N/A

Machanical lifting

• Isolate work area (barricade) avoid unauthorise personnel near lifting area

  Yes

  No

  N/A

• Presence of lifting supervisor,flagman to monitor lifting activites

  Yes

  No

  N/A

• Permit for crane or other chain machine

  Yes

  No

  N/A

• Competent operator

  Yes

  No

  N/A

• Safe handling of machine exp not use machine to transport personnel

  Yes

  No

  N/A

• Safe practice in lifting (not walk beneath suspended load, not ride on suspended load etc)

  Yes

  No

  N/A

• Machine secured on ground (not slippery, soft ground etc.)

  Yes

  No

  N/A

• Overall inspection comments

• Picture of worksite

  Media

• Signature

  Sign