Title Page

  • Document No.

  • Type of document

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Worksite inspection

  • Type of work

  • Site location
  • Date and time

Site access

  • Complete permit to work form

  • Worker have valid NTMSP

  • Worker have valid AESP and AGTES card

General safety requirement at site

  • Toolbox briefing before work

  • All worker wear personal protective equipment (PPE)

Emergency preparedness and hygiene

  • Fire extinguisher present

  • First aid present

  • Clean water and other hygiene tools

Confine space entry

  • Confine space permit to work

  • Atmosphere testing before entry

  • Safe continuous ventilation

  • Isolating manhole (barricade)

  • Communication between authorise entrant and stanby person

  • 'Warning confine space' signage present

Working at height

  • 10 feet above ground worker wear harness

  • Ladder in good condition

  • Ladder secured for working

  • Buddy system working on ladder

Trenching and excavating work

  • Tool and equipment place 1 meter from hole

  • 1.2 meter above use ladder used for ingress

  • 1.5 meter above shoring installation with PE endorse present

  • No heavy machinery activity near

Working near power line

  • Clearing area 3 meter from power line

  • Supervision,signalman,flagman etc.

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

Machanical lifting

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

  • Presence of lifting supervisor,flagman to monitor lifting activites

  • Permit for crane or other chain machine

  • Competent operator

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

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

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

  • Overall inspection comments

  • Picture of worksite

  • Signature

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.