Melbourne Water MPD Lead HSEQ Activity Check List (Rev A)

• MDP Project Site

• Project Name

• Conducted on

  Date

• Prepared by

• Personnel

Work Activities Conducted on Site

• Select Excavation activities Confined space entry Floating cover installation Pipe relining works Earthworks Pipeline installation Structural works Working on over or near water Traffic management Electrical/Instrumentation commissioning Pump installations/removal Hydro excavation Dredging works Valve/Penstock installation works Building refurbishment works Roadworks Welding activities Crane activities Road construction Electrical/Instrumentation commissioning Mechanical commissioning Concrete placement Working at height Roofing works Mechanical works Electrical/Instrumentation works Environmental works

  • Excavation activities
  • Confined space entry
  • Floating cover installation
  • Pipe relining works
  • Earthworks
  • Pipeline installation
  • Structural works
  • Working on over or near water
  • Traffic management
  • Electrical/Instrumentation commissioning
  • Pump installations/removal
  • Hydro excavation
  • Dredging works
  • Valve/Penstock installation works
  • Building refurbishment works
  • Roadworks
  • Welding activities
  • Crane activities
  • Road construction
  • Electrical/Instrumentation commissioning
  • Mechanical commissioning
  • Concrete placement
  • Working at height
  • Roofing works
  • Mechanical works
  • Electrical/Instrumentation works
  • Environmental works

• Other site activity not noted on the pick list:

Discussions with Site Workers

• Tell me about the works on site ?

  Select Comprehensive understanding Understanding of specific tasks only Works under direction only Low level of understanding

  • Comprehensive understanding
  • Understanding of specific tasks only
  • Works under direction only
  • Low level of understanding

• What's your companies safety approach and beliefs ?

  Proactive

  Compliance only

  Innovative

  Rather not comment

• How would you rate safety on this project -scale of 1 - 10 ? (10 = Great 1 = Not good)

• What sort of documentation do you have for working safely on site ?

  Select SWMS Procedures Workpacks AMS Work Permits

  • SWMS
  • Procedures
  • Workpacks
  • AMS
  • Work Permits

• Are there any site specific requirements related to the work you are doing at present including MW requirements, if so what are they ?

  Yes

  No

• Do you attend Toolbox meetings ?

  Select You are comfortable you can have your say Relevant topics are discussed Items raised at the TB meetings turn into actions where possible

  • You are comfortable you can have your say
  • Relevant topics are discussed
  • Items raised at the TB meetings turn into actions where possible

• Other comments:

• How do you find the incident reporting culture on site ? (10 = Great 1 = Not good)

• What sort of incidents get reported ?

  Select First Aid Medical Treatment Lost Time Injuries Near Miss High Potential Incidents Environmental Incidents Plant/Property

  • First Aid
  • Medical Treatment
  • Lost Time Injuries
  • Near Miss
  • High Potential Incidents
  • Environmental Incidents
  • Plant/Property

• Does your Emergency Evacuation process work ?

  Yes - Rehearsed went well

  Rehearsed but went badly

  Not undertaken at this time

Work Environment and Conditions

• Housekeeping and Layout:

  Safe

  At Risk

  N/A

• Barricades and Signage:

  Safe

  At Risk

  N/A

• Security of equipment:

  Safe

  At Risk

  N/A

• Environmental controls reviewed:

  Select Sedimentation controls fences/ bags/matts Noise/Dust controls Flora and fauna controls Vibration controls Cultural heritage requirements Waste management controls Stockpiling controls Soil disposal tracking Hazardous substances used and stored correctly with MSDS available ?

  • Sedimentation controls fences/ bags/matts
  • Noise/Dust controls
  • Flora and fauna controls
  • Vibration controls
  • Cultural heritage requirements
  • Waste management controls
  • Stockpiling controls
  • Soil disposal tracking
  • Hazardous substances used and stored correctly with MSDS available ?

• Other controls not noted on the pick list:

• Environmental controls adequate ?

  Yes

  No

  N/A

Systems/Standards/Procedures

• Competence for task:

  Select Certificates of Competency recorded Verification of Competency undertaken Records not available

  • Certificates of Competency recorded
  • Verification of Competency undertaken
  • Records not available

• Other comment:

• Lock-out and Tag-out:

  LOTO system in place and utilised when required

  LOTO not implemented

• Work Permits required/used on site:

  Select Melbourne Water Permit for works Trenching Permit Confirmed Space Entry Permit Council Approvals EPA Worksafe Notification for Excavation

  • Melbourne Water Permit for works
  • Trenching Permit
  • Confirmed Space Entry Permit
  • Council Approvals
  • EPA
  • Worksafe Notification for Excavation

SWMS - Pre Start Checks

• Pre Start Records:

  Select Attended by all staff Records available Discussion covers daily activities

  • Attended by all staff
  • Records available
  • Discussion covers daily activities

• SWMS Available:

  Yes

  No

  N/A

• SWMS Adequate:

  Yes

  No

  N/A

• SWMS Understood:

  Yes

  No

  N/A

• SWMS Followed:

  Yes

  No

  N/A

Tools and Equipment

• Availability:

  Tools and equipment on site and adequate

  Tools and equipment not on site or not adequate

• Condition:

  Safe

  At Risk

  N/A

People and Behaviours

• Are employees ensuring they are not placing themselves in Line of Fire ?

  Yes

  No

  N/A

• Are employees selecting appropriate Tools and Equipment and wearing correct PPE ?

  Yes

  No

  N/A

• Are employees keeping Eyes on Hands whilst doing works which could result in injury ?

  Yes

  No

  N/A

• Are employees Looking Before Moving ?

  Yes

  No

  N/A

• Are employees Communicating their intent to others ?

  Yes

  No

  N/A

• Are employees using correct manual handling techniques to maintain correct Position and Effort ?

  Yes

  No

  N/A

• Are employees Assessing and Re-assessing the area ?

  Yes

  No

  N/A

• Are employees maintaining Eyes on Path whilst moving around the worksite ?

  Yes

  No

  N/A

Protection systems

• Is electrical equipment positioned appropriately with current test and tag ?

  Yes

  No

  N/A

• Are fire extinguishers positioned correctly with clear access and in test and tag ?

  Yes

  No

  N/A

• Scaffold systems inspected and tagged ?

  Yes

  No

  N/A

High Risk Activities

• Are Trenching activities being carried out in accordance with legislative requirements ?

  Yes

  No

  N/A

• Are Confined Space Entries being carried out in accordance with MW procedural requirements ?

  Yes

  No

  N/A

• Are activities being carried out On, Over or Near Water being undertaken in a safe manner ?

  Yes

  No

  N/A

• Are employees using appropriate controls for ascending and descending to and from work areas >2mt

  Yes

  No

  N/A

• Are required controls in place for HV activities ?

  Yes

  No

  N/A

• Are required controls in place for Crane/Lifting activities

  Yes

  No

  N/A

ADDITIONAL POSITIVE OBSERVATIONS

• Note Positive Observations:

• Photos to support observations:

  Media

ADDITIONAL OPPORTUNITIES FOR IMPROVEMENT

• Note opportunities for improvement:

• Photos to support identified opportunities for improvement:

  Media

• Provide a sketch of the area of concern if applicable to support findings:

  Drawing

Other Comments

• Note other comments here:

Sign Off

• Person conducting the Lead HSEQ Activity:

• Signature of the person conducting the Lead HSEQ Activity:

  Sign

• Name of the Workplace Manager:

• Signature of the Workplace Manager:

  Sign