Title Page
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Conducted on
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Prepared by
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Location
Team Details
Worksite Team Members
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Worksite Team Members
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Name
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Service Number
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Worksite Team Role
- Leading Hand / Worksite Co-ordinator
- Observer
- Working Aloft
- Plant Operator
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Authorisation in Date ?
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Authorisation Number
Worksite Setup
Work Group and Site Setup
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Overall photograph of task to be completed ( Pre-Job Commencing )
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WHRA Completed and Group Discussion .
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Photo of Front and Back of WHRA
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Is all Paperwork for task on site and Correct.
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Is there adequate staff on site to complete task.
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Is there Adequate Communication at Worksite. ( Telephone / Two Way Radio )
Equipment
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Condition of Insulation Equipment
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Provision for suitable Equipment Storage.
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Preparation of Insulation Equipment.
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Is the Ladder in good condition and Inspected prior to climbing.
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Are the Pole Platform/s in good condition and inspected prior to use.
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Are the tool/s being used for task in good condition and inspected prior to use.
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Is Rescue Equipment in date and in good Condition.
Personal Protective Equipment ( PPE ).
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Arc Rated Clothing - Long Pants & Long Sleeve worn & in acceptable condition.
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Safety Footwear worn & in acceptable condition
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Hard hat worn, in acceptable condition and in date.
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Approved eye protection worn & in acceptable condition.
Insulating Gloves
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Leather Protector gloves in good condition and inspected prior to use.
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Inspection and Inflation test Performed prior to use.
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Are the Insulating gloves stored correctly.
Harnesses / Lanyards and Pole Straps.
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Are Pole climbing harnesess and Straps in good condition.
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Is the bucket harnesess and lanyards in good condition.
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Within 10 year service life from date of manufacture.
EWP
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EWP
Elevated Work Platform
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Cleanliness/ Condition of Boom and Basket.
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EWP Plant Number.
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Excess gear removed from Basket.
EWP setup
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Position of EWP relative to job.
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Photograph of EWP positioning.
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Stability of EWP / Correctly setup.
Climbing Setup.
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Climbing Setup
climbing setup
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Is ladder correctly positioned on pole and correctly secured.
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Are Pole Platform/s removed from vehicle and ready to be used for the task being performed.
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Is the Pole Top Rescue Kit removed from vehicle and ready .
Testing
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Bucket Insulation within test date.
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Test Date
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Photograph of Test Sticker.
Borer Erector.
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Borer/Erector.
Borer / Erector
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Endeavour Energy lifter borer / plant.
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Name and Service Number
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Authorisation Number.
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Date of Authorisation.
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Contractor - lifter borer/plant
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Company Name.
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Plant Operators Name.
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Plant Operators Authorisation Number.
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Date of Authorisation.
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Plant Operators dressed in Compliant Clothing.
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Borer in Test Date.
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Test Date.
Vehicle Equipment.
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Overall hydraulic system condition. ( Leaking ? )
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All lifting equipment in good condition.
Safety
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Quality of EWP positioning and movements.
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Quality of Borer/ Erector positioning and movements.
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Position of Borer/ Erector relative to work.
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Photograph of Borer / Erector position.
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Quality of communication between Borer Operator and Plant Safety Observer.
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Safe work practices being utilised.
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Photographs of Borer / Erector operation during job.
Task/s Being Performed
Task/s being Performed.
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Are Safe Work Clearances being maintained.
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Is Temporary Insulation being correctly applied from EWP or Pole.
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Is the Temporary Insulation properly secured and being utilised correctly.
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Are the Pole Platform/s at a good height for Temporary Insulation installations.
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Are the Pole Platform/s a good height for the task/s being performed.
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General quality of the work being performed.
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Attitude towards Low Voltage Work task/s overall.
Safety Observer
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Has a Safety Observer been appointed.
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Is the Safety Observer aware of the task/s that are being performed.
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Is the Safety Observer in good position .
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Safety Observers position.
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Communication between Safety Observer and workers aloft.
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Communication between workers aloft and their Interaction.
Follow Up Actions
Follow up Actions.
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Follow up Actions.
Follow up Actions
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Responsible Person.
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Follow up Action.
Audit Rating.
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Overall Comments from Auditor.
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Overall Rating of Audit.
- Compliant
- Non Compliant
Completion.
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Auditor confirms the findings of the audit. ( Sign )
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Auditee endorsement: I am a representative of the work crew. ( Sign )
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Auditee comments.
