Information

  • Contractor Company

  • Neutrogena Sponsor/Sponsor Contact

  • Conducted on

  • Prepared by

  • Project Name
  • Personnel

Contractor Documentation

  • Contractor Job Review Form completed?

  • JHA completed?

1. Working at Heights

  • 1.1. Fall risks of 6ft. or more? (including voids, pits, and trenches)

  • 1.2. Not tied off while operating an aerial lift?

  • 1.3. Unlicensed operators?

2. Equipment

  • 2.1. Unsafe or damaged equipment? (including missing or damaged guards)

  • 2.2. Incorrect equipment for job? (e.g. grinding discs for cutting)

  • 2.4. Unlicensed operators?

  • 2.7. Lack of LOTO procedures for cleaning, servicing and maintenance?

  • 2.8. Lack of inspection regime?

  • Equipment properly labeled?

3. Scaffolds

  • 3.1. Unlicensed persons erecting scaffold?

  • 3.2. Unsafe or incomplete scaffold?

  • 3.3. Lack of inspection protocol for scaffold?

  • 3.5. Safe Work Load (SWL) exceeded? (tools, stored materials, number of persons)

4. Lifting Equipment

  • 4.2. Loads lifted over persons, close proximity to obstacles incl. overhead power lines?

  • 4.3. Lack of maintenance, testing and inspection?

  • 4.4. Lack of SWL information displayed?

  • 4.5. Lack of daily inspection protocol?

  • 4.6. Unsafe or damaged lifting equipment, including ropes, slings, chains, hooks?

  • 4.9. Lack of LOTO procedures for cleaning, servicing and maintenance?

  • 4.10. SWL of plant or any lifting equipment exceeded?

5. Harness and Equipment

  • 5.2. Incompatible hooks/equipment?

  • 5.3. Unlabelled or does not meet AS?

  • 5.4. Unsafe or uncertified anchor points?

  • 5.5. Lack of inspection protocol for equipment?

  • 5.6. Lack of or inadequate formal training for operators?

Excavations

  • J&J Excavation permit completed?

  • Competent Person onsite?

  • GPR scan completed?

Hot Work

  • Hot Work permit present at worksite?

  • Hot Work permit and Fire Watch log properly completed?

  • Fire Extinguisher present?

6. Ladders

  • 6.1. Unsafe or damaged ladders?

  • 6.2. Unsafe positioning of ladders?

  • 6.3. Ladder not properly secured?

  • 6.4. Ladder unsuitable for job? (Improper ladder selection)

7. Hazardous Manual Tasks

  • 7.1. Lack of identification hazardous manual tasks?

  • 7.2. Lack of assessment of hazardous manual tasks?

  • 7.3. Inadequate risk controls? (examples: no job rotation, lighter loads, trolleys, lifting equipment, etc)

  • 7.4. Lack of training in risk controls and safe lifting/ team lifting techniques?

8. Hazardous Chemical (including fuel and oil)

  • 8.1. Unsafe storage location? (e.g. flammables near ignition sources, spills could enter stormwater drains, etc)

  • 8.2. Incompatible chemicals stored near each other?

  • 8.3. Inadequate spill containment equipment?

  • 8.4. Safety Data Sheets not accessible on site?

  • 8.5. Lack of emergency procedures for injury/spills/fire etc?

  • 8.6. Excessive quantities stored on site or in vehicles?

  • 8.7. Insufficient ventilation?

  • 8.8. Insufficient, or incorrect, PPE?

  • 8.9. Unsuitable storage containers? (unlabeled or stored in food containers)

9. Emergency Response

  • 9.1. Lack of, or no emergency plans for site?

  • 9.2. Emergency procedures not displayed at site?

  • 9.3. Lack of training and rehearsal of emergency plans?

  • 9.4. Lack of, or inadequate first aid kits aid equipment for site?

  • 9.6. Unsuitable or inadequate communication equipment?

11. Personal Protective Equipment (PPE)

  • 11.1. Lack of, or inadequate PPE (including sun protection)

  • 11.2. Lack of system to issue, inspect, replace and monitor PPE?

  • 11.3. Lack of training in safe use, clean-up and inspection of PPE?

12. Work Environment

  • 12.2. Insufficient lighting?

  • 12.3. Inadequate housekeeping?

  • 12.4. Lack of, or inadequate noise/ vibration control?

13. Electrical Hazards

  • 13.1. Unsafe electrical leads? (damaged, out of test date or untested)

  • 13.2. Lack of RCD protection?

  • 13.3. Contact with underground assets?

  • 13.4. Contact with overhead electrical lines?

  • 13.5. Overloading outlets?

  • 13.6. Leads placed on ground or on metal structures?

  • 13.7. Electrical equipment near water?

  • 13.8. Electrical equipment near flammables?

  • 13.9. Electrical equipment near chemicals that could cause damage?

  • 13.10. Electrical leads that may be damaged from contact with moving machinery parts?

  • 13.11. Electrical leads on work surfaces?

  • 13.12. Lack of Lock-out/tag-out (LOTO) procedures for electrical equipment?

14. Environmental Hazards

  • 14.1. Lack of/or inadequate Environmental Management plan (EMP)?

  • 14.2. Lack of/or inadequate, dust suppression system?

  • 14.3. Lack of/or inadequate systems to prevent contaminants entering stormwater drains?

  • 14.4. Lack of water re-use systems?

15. Administrative Procedures

  • 15.1. Lack of/or inadequate Site Safety Plan?

  • 15.2. Failure to obtain permits (Hot Works, Confined Space, Roof Access, Excavation, etc)

  • 15.3. Lack of, or inadequate, induction for workers, contractors, visitors?

  • 15.4. Lack or, or inadequate, supervisory arrangements?

  • 15.5. Lack of/or inadequate training, licenses, skills, experience?

  • 15.6. Lack of/or inadequate Safe Work Method Statements (SWSM) for high- risk work?

  • 15.7. Lack of, or inadequate system to review SWMS as needed?

  • 15.8. Lack of/or inadequate incident notification procedures?

  • 15.9. Lack of, or inadequate, routine inspections, monitoring, audits?

16. Observations

  • 16.1. Any observations issued?

Corrective Actions

  • Enter any corrective actions that will be undertaken

Sign Off

  • On site representative

  • Auditor's 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.