Information

  • Audit Title

  • Document No.

  • Client / Site

  • Job/Project No.

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Vehicle Registration No.

Photo of work site

  • Work site

JSA

  • Has JSA been completed correctly

  • Has the JSA been signed by all parties

Training

  • Have all personnel been trained for the task

Traffic Management

  • Signs appropriate for job

  • Signs well located and visible

  • Sufficient cones used

  • Signs in good condition

  • Appropriate vests in use

  • Work site well protected (personnel, plant, etc)

  • Personnel trained in traffic management

Worksite Gaurding

  • Pedestrian traffic managed

  • 1.2 metre clearance for pedestrian traffic maintained, free of trip hazards

  • Open pits/manholes gaurded

  • Cones in use and correctly used

Personal Protective Equipment

  • Correct PPE in use and appropriate for task

  • Safety boots worn

  • Long sleeve shits and trousers worn

  • Safety glasses worn

  • Hearing protection worn

  • Gloves worn

  • Is the PPE well maintained ie. clean, not broken

  • UV protection in use (hats, sunscreen etc)

Gas Detectors

  • Gas detector calibrated and worn

  • Before entry manhole testing done (Test, Vent, Test, Monitor)

  • Gas detector reading is within acceptable limits and recorded (20.9, 0, 0, 0)

Vehicles

  • Vehicle registered and maintained

  • Fire extinguisher available and maintained

  • Sharps bin available

  • Invertor and aux battery operational

  • Visionstream Blue Book available and up to date

Chemicals/Substances

  • Are MSDSs available?

  • Are MSDSs up to date?

  • Have precautions been observed

  • Labelled clearly

  • Stored appropriately

Environmental

  • Risks and hazards identified

  • Are site specific requirements being followed?

  • All waste removed

First aid

  • First aid kit labelled

  • Contents within date, sealed, sterile etc

Manual handling

  • Assess material to be lifted

  • Use correct lifting techniques

  • Lifting aids use properly

Work Practices

  • Plant and equipment appropriately set up

  • Clean and tidy worksite

Electrical Tools

  • Test and tag in date

  • RCD used

  • Tools fit for use

Heat, working in hot conditions

  • Appropriate clothing worn

  • SPF 30 sunscreen in use

  • Utilise shade where possible

  • Drinking water available

Confined Space Entry

  • Confined space risk assessment complete

  • Entry permit complete

  • Standby person/safety observer on site

  • Personnel trained

  • Retrieval system in place

  • Communications established

  • Team leader notified prior to entry

  • Required PPE in place (ie, gas detector, fall arrest system, safety boots,, hard hat, gloves, etc) <br>

Asbestos

  • Use correct PPE - P2 Half face respirator, Disposable overalls, Disposable gloves

  • Wet down asbestos material

  • Use non powered tools

  • Asbestos bags used for disposing of asbestos

  • Asbestos disposed of in appropriate disposal bins.

Contaminated water

  • Water disposed of via Pump Truck

  • Use correct PPE

Dust

  • Isolations/Permits applied for and in place

  • Approved dust suppression methods/tools used

  • PPE used

Hoist

  • Hoist serviced and within date

  • Pre start inspection completed

  • Personnel trained and certified

  • Permits obtained

  • Warning signs in place

  • Emergency procedures documented

Humans, Insects and Animals

  • Site assessed for potential animals/insects

  • Pets restrained or removed

  • Correct PPE in use

Driving

  • Driving hazards identified and controlled

  • Seat belts worn

  • 15 minute break after driving for 2 hours

Electrical - Communications racks/ DC systems

  • Equipment earthed

  • Mains Isolated

  • Jewellery removed

  • Double insulated tools in use

Electrical - Overhead

  • Test and tag in date

  • RCD in place

  • Tools fit for service

  • PPE in use

Fire

  • Emergency procedures available

  • No welding, grinding near ignition sources

  • No hot works in long grass during fire season

  • Fire extinguisher available

Sharps

  • Sharps bin available

  • Fibre offcuts placed in in Sharps bin

  • Sharps bin resealed at completion of task

Lasers

  • Eye protection in place

  • Video scope used

Lightning

  • Shelter taken

Self-Loading Trailer

  • Trailer serviced

  • Operator trained and competent

  • Pedestrians controlled

  • Ground surface flat/level

Trains

  • Staff have L1 rail safe training

  • Victrack approved vests worn

  • Rail protection plan in place

Working at heights - ladders

  • Ladder fit for duty

  • Work below safe working height of ladder

  • Ladder setup correctly

Working at heights - Poles

  • Visual inspection of pole completed

  • Push test completed

  • Hammer test completed ( wooden poles only)<br>

  • Ladder safety observed

Working at Heights - Roof

  • Roof checked for stability

  • Access to roof is secure and safe

  • Fall protection in place

  • People protected from falling material

Working hours, Fatigue

  • Team manager aware of after hours work

  • Breaks taken as required

  • 10 hour break taken between shifts

Other hazards not identified above

Comments/issues observed

  • Photos of any issues observed

  • Photos of any issues observed

  • Photos of any issues observed

  • Photos of any issues observed

  • Photos of any issues observed

Signature

  • Auditor

  • Worker

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.