MGN Leadership Engagement

• Document No.

• Audit Title

• Job Description

• Location
  Address

• Conducted on

  Date

• Prepared by

• Contract

  OMSA

  Projects

• Service Provider

  Comdain

  Downer

  Diona

  Ventia

  Zinfra

• Contractor(s)

• Work Group (name of crew leader & members)

Observations

• RISK MANAGEMENT - SWMS, JSA, controls, procedures, traffic management<br>Is there a JSA and SWMS? Does the work appear to be in accordance with both?

  Safe

  At Risk

  N/A

• PPE - Clothes, Eyes, Head, Hands, Feet, Respiratory, Radiation<br>Is PPE in generall good condition and being used correctly?

  Safe

  At Risk

  N/A

• ERGONOMICS - Lifting, pushing, pulling, repetition, exertion, design<br>Note the physical movements and positions of people

  Safe

  At Risk

  N/A

• TOOLS, PLANT and EQUIPMENT - Condition, availability, use, serviced, in test<br>Are tools in good condition and being used appropriately?

  Safe

  At Risk

  N/A

• ENVIRONMENT - Flora, fauna, spills, dust, spoil, waste<br>Is the site free of uncontrolled potential for environmental impact?

  Safe

  At Risk

  N/A

Comments

• Summary of safe behaviours [including actions]

• Summary of less safe behaviours [including actions]

• Rating of at risk behaviours

  Minor

  Moderate

  Severe

  Major

  Catastropic