Information
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Type of work
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Conducted on
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Prepared by
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Location
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Trim #
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Type of Work
- Pot Hole
- Asphalting/Road Patching
- Concrete Maintenance
- Drainage Maintenance
- Retaining Walls
- Road Tubes
- Signage Installation
- Stormwater Drain Repair
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Job Number
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Photo before work
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Site Risk Assessment (SSRA) & Induction Record
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Are traffic, pedestrian, public access controls or exclusions zones required? Has a Traffic Control Plan (TCP) been developed?
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Which methods are being used?
- TCP plan in place
- Qualified Traffic Controller
- Exclusion Zones - Signage, bunding, fencing
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Are staff performing the work competent and authorised and if required, is supervision provided for apprentices, trainees, contractors, volunteers and visitors?
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Requirements checked
- All workers are competent
- Ticketed/Licensed
- Required persons have sufficient supervision
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Are all plant, tools and equipment (including hire equipment) in safe operating condition and fit for purpose?
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Which checks have been completed?
- Pre-start safety check
- Periodical maintenance
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Is there any danger to or resulting from people, dogs, insects, reptiles or property?
- People
- Dogs
- Insects
- Reptiles
- Property
- N/A
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Which methods are being used?
- Necessary equipment available (Dog catching, Wasp Spray)
- PPE
- Not working alone
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Are environmental hazards present at this worksite? If so, which ones?
- Sediment
- Waste
- Noxious weeds
- Decaying animals or plants
- Hazardous Substances/Chemicals
- Spills or leaks
- Fire
- Asbestos
- Other
- N/A
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Safe disposal of waste
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Asbestos work procedure
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Erosion Sediment control plan
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All safety data sheets are available
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Other
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Apart from protective clothing and footwear, is additional Personal Protective Equipment (PPE) required for this worksite?
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What is required?
- Traffic Vests
- Safety Helmets
- Gloves
- Eye protection
- Hearing protection
- Dust mask
- Sun protection
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Are other protective items required?
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Other
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Are manual handling tasks involved?
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What methods will be used to reduce the risk?
- Eliminate the need for manual handling
- Mechanical Aids
- Technique
- Have someone assist with the lift
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Are you required to use ladders or work at heights above 2 meters?
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What methods will be used to reduce the risk?
- Attached Climbing
- Ladder secured
- Rescue Kit
- Elevated platform with competent operator
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Are underground cables and other utilities identified.
- Telephone
- Power
- Water
- Sewer
- Other
- N/A
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Other
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What methods will be used to reduce the risk?
- Dial Before You Dig
- Hand digging to locate
- Clearly mark identified utilities to identify to all staff
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Is work being conducted near overhead power or phone lines?
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What methods will be used to reduce the risk?
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Is the work to be performed in a confined space?
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Minimum of two qualified staff to undertake work following SWMS and all other requirements.
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Is there a risk of persons being injured or drowned as a result of the collapse, failure or flooding of an excavation?
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Which control measure apply? (excavation deeper than 1.5m MUST be shored).
- Barriers/Fencing
- Covering
- Backfilling
- Shoring Benching
- Battering
- Inspection of excavation & support systems
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Where required have exclusion zones for the public, workers on foot and other vehicles been set?
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What methods will be used to reduce the risk?
- Set and communicate exclusion zones
- Barriers or fencing
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Have contractors licences/competencies been checked?
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What has been checked?
- Working near power
- Asbestos
- Other
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Other
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All persons at this site to be consulted in this SSRA & job task SWMS and are aware of all identified hazards and control measures.
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Methods used:
- Risk assesment communicated and signed by all persons on the job site
- All job tasks SWMS are available
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Are emergency procedures communicated and understood, and appropriate First Aid facilities available.
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Procedures communicated/facilities available:
- Emergency procedure
- First Aid Kit
- Trained First Aid Officer or means to contact emergency services available
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Photos after Work
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Signature
