Mobile Site Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General

• Have all visitors signed the visitor log.

  Yes

  No

  N/A

• Are hazards and controls discussed with visitors prior to entering the site?

  Yes

  No

  N/A

• Hazard ID identifies current hazards relating to the site activities

  Yes

  No

  N/A

• Hazard ID controls relevant to the hazards and have assigned responsibilties?

  Yes

  No

  N/A

• Plant and equipment register complete and on site?

  Yes

  No

  N/A

• Incident report register on site and up to date?

  Yes

  No

  N/A

• Measuring and test equipment calibration register complete and on site?

  Yes

  No

  N/A

Worksite Management

• Hazardous substance register completed and/or related MSDS's sheets on site?

  Yes

  No

  N/A

• PPE selected, used and adequate for the activity and environmental hazards present?

  Yes

  No

  N/A

• Is the work site (including footpaths and roadway) clear and free from debris, rubbish and obstructions?

  Yes

  No

  N/A

• Are slip and trip hazards being adequately managed?

  Yes

  No

  N/A

• Are unattended excavations backfilled, plated or fenced?

  Yes

  No

  N/A

• Dust and noise on site is minimised or elimiinated

  Yes

  No

  N/A

• Are facilities for workers available e.g Portaloos, Hand Washing Facilities

  Yes

  No

  N/A

Working at Heights

• Has a risk assessment been conducted for the site and signed off and communicated to all people on site

  Yes

  No

  N/A

Mobile Elevated Work Platforms

• Has the operator carried out a pre start inspection that includes functional and visual tests (required each day)

  Yes

  No

  N/A

• Is the MEWP clearly marked with the rated lifting capacity?

  Yes

  No

  N/A

• Is the six monthly inspection certificate displayed?

  Yes

  No

  N/A

• MEWP is set up level and on firm surfaces and does not exceed the slope rating (stated on the manufacturers stability certificate)

  Yes

  No

  N/A

• Operator is trained and competent (US 23966v1 and the corresponding US for the type of MEWP being used)

  Yes

  No

  N/A

• Hazards associated with power-lines are appropriately controlled (no closer than 6.4 metres or between 4 - 6.4 metres if appropriate controls are in place). No work can be carried out within 4 metres of a power line without written consent from the power line network holder and this consent must be on site at all time).

  Yes

  No

  N/A

• Weather conditions are suitable for using a MEWP?

  Yes

  No

  N/A

• Manual for MEWP available in English?

  Yes

  No

  N/A

Excavation and drilling

• Excavation and drilling permit completed and available

  Yes

  No

  N/A

• Permit is current for the location?

  Yes

  No

  N/A

• Have all current proximity permits been obtained from utility owners?

  Yes

  No

  N/A

• Close approach permit if plant or people are working within 3 metres of overhead cables?

  Yes

  No

  N/A

• Are current utility clearance plans onsite?

  Yes

  No

  N/A

• All relevant services marked?

  Yes

  No

  N/A

• All relevant services located?

  Yes

  No

  N/A

• Service plans have locators, site managers, site supervisors, and contractor crews signatures?

  Yes

  No

  N/A

• Only techniques approved on the permit being used?

  Yes

  No

  N/A

• Excavations deeper than 1.5 metres are notified to Worksafe NZ?

  Yes

  No

  N/A

• Has a services spotter been allocated to excavator?

  Yes

  No

  N/A

• Are trenches greater than 1.5 metres deep (or where appropriate) battered, benched or supported?

  Yes

  No

  N/A

Traffic Management

• Copy of the traffic management plan maintained on site?

  Yes

  No

  N/A

• Traffic management setup is correct and according to the approved TMP?

  Yes

  No

  N/A

• Is there are escape route for the traffic controller?

  Yes

  No

  N/A

• STMS contact number listed?

  Yes

  No

  N/A

• After hours TMP in place?

  Yes

  No

  N/A

• Cones and barriers in good condition?

  Yes

  No

  N/A

Plant and equipment (including mobile plant)

• All mobile plant and machinery maintained within the confines of the established TMP under COPTTM requirements?

  Yes

  No

  N/A

• Safe reversing procedures are being followed?

  Yes

  No

  N/A

• Vehicles are parked safely?

  Yes

  No

  N/A

• FOPS,ROPs,COPS,OPS certification (if required) for mobile plant? <br>

  Yes

  No

  N/A

• WOF/COF/Registration/RUC current?

  Yes

  No

  N/A

• Drivers/Operator licences and endorsements available?

  Yes

  No

  N/A

• Are machinery operators wearing sear belts

  Yes

  No

  N/A

Public safety and pedestrian access

• Is safe pedestrian access maintained on site at all times?

  Yes

  No

  N/A

• Trenches are cordoned off?

  Yes

  No

  N/A

• Are appropriate barriers in place?

  Yes

  No

  N/A

• Manholes and pits are made safe?

  Yes

  No

  N/A

• Does TMP cater for people with disabilities and also for children?

  Yes

  No

  N/A

• When plant and machinery (e.g diggers, drills etc) are in operation these are isolated from the general public?

  Yes

  No

  N/A

• Are ramps compliant?

  Yes

  No

  N/A

Emergency planning and equipment

• Is the site able to call for emergency assistance - Fire, Police, Ambulance?

  Yes

  No

  N/A

• Emergency assembly point identified

  Yes

  No

  N/A

• Are first aid kits readily available and well stocked?

  Yes

  No

  N/A

• Are appropriate Fire Extinguishers available on site?

  Yes

  No

  N/A

• Has an emergency plan been prepared to cover a line strike and any other emergencies?

  Yes

  No

  N/A

• Are spill kits available?

  Yes

  No

  N/A

Confined spaces (If present on site)

• Is there a Confined Space Management (CSM) plan on site

  Yes

  No

  N/A

• Is there a competently trained CSM Supervisor on site?

  Yes

  No

  N/A

• Entry permit system in use to manage CS work?

  Yes

  No

  N/A

• Is there a standby person stationed outside the CS while work in progress?

  Yes

  No

  N/A

• Does the CSM plan describe the emergency rescue procedures?

  Yes

  No

  N/A

• Is emergency rescue equipment at or near the entry?

  Yes

  No

  N/A

• Before entry to CS, is atmospheric testing carried out?

  Yes

  No

  N/A

• During work in CS, is atmospheric testing carried out?

  Yes

  No

  N/A

• Oxygen monitors available if required?

  Yes

  No

  N/A

Environmental management

• Site specific tree plan on site and signed off by local authority?

  Yes

  No

  N/A

• Spill response plan available and understood?

  Yes

  No

  N/A

• Spoil containment and removal (including stockpiles) managed?

  Yes

  No

  N/A

• No backfill stored on roads within 50 cm of environmentally sensitive areas i.e drains, streams and/or dumps leading to storm water pits?

  Yes

  No

  N/A

• Storm-water sediment traps and gutter guards for water run off in place (50 metres down run of any excavation site or stockpiles)?

  Yes

  No

  N/A

• Drop sheets under backfill on the ground?

  Yes

  No

  N/A

• Fibre offcuts and ribbonet off cuts being recycled?

  Yes

  No

  N/A

Summary - If any of the following areas are not compliant then work at the site should be halted until the area of concern is addressed

• If any of the following safety critical areas are not compliant then work at the site should be halted until the area of concern is addressed

• A permit to work exists for drilling and excavation

  Safe

  At Risk

  N/A

• A traffic management plan is in place?

  Safe

  At Risk

  N/A

• Pedestrian safety is being maintained?

  Safe

  At Risk

  N/A

• Hazards have been identified for the site and appropriate controls are in place

  Safe

  At Risk

  N/A

Agreement

• Required corrective/preventative actions

• Agreed date of completion

• Select date

  Date

• Auditor

  Sign

• Site representative

  Sign