Monthly HSE Inspection Template

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A

Home

• Document Revision Information

  Yes

  No

  N/A

Monthly Home

Monthly Audit

• Ашиглах заавар: Энэхүү сар тутмын хяналт шалгатын хуудас нь ХАБЭАБОны үзлэг шалгалтын зориулалтаар хийгдсэн болно. ХАБЭАБОны нийцлийн шалгуур үзүүлэлтийн тоо нь тухайн салбар нэгжийн онцлогоос хамаарна. Хэрэв тухайн салбар нэгжид тухайн хэсэг хамааралгүй бол бөглөхгүй байж болно. Тухайн хэсэг тус бүр Y, N, NA гэсэн хариулттай. Танай салбар нэгжийн нийцлийн үр дүн зөвхөн Y, N гэсэн хариултад тулгуурлан автоматаар бодогдож гарч ирнэ. Хяналт шалгалт дууссаны дараа "Сарын Хяналт Шалгалтын Үр дүнгийн Тайлан" дээр дарж, үл нийцлийн тайлангаа гаргана. "Үл нийцлийн жагсаалт" товчин дээр дарахад жагсаалт нь автоматаар гарна. Хариуцах эзэн болон эцсийн хугацааны багануудыг бөглөнө. Илэрсэн үл нийцлүүдийн хувьд одоогийн төлөв байдал болон авах арга хэмжээний багануудыг бөглөнө. Хяналт шалгалтын тайланг сар бүрийн сүүлийн Баасан гарагаас өмнө гаргаж, HSE SharePoint дээр тавих хэрэгтэй бөгөөд дараа сарын эхний долоо хоног дуусахаас өмнө нэвтэрч үзэх боломжтой байна

  Yes

  No

  N/A

• Line

  Yes

  No

  N/A

• Хамгаалалтын бээлий нь тусгай химийн бодистой ажиллахад тохиромжтой эсэх Хэрэглэж байгаа бодисын MSDS ийг шалгаж өгч байгаа бээлий тухайн шаардлагыг хангаж байгаа эсэхийг шалгах

  Yes

  No

  N/A

Бүх бодисуудыг дэлхий нийтэд хүлээн зөвшөөрөгдсөн систем буюу GHS ын шаардлагуудын тодорхой бөгөөд зөв хаяглагдсан байна уу? Шилэн эдлэлүүдийн нөхцөл байдал хэвийн бөгөөд хагарсан шил савыг ашиглалтаас хассан байна уу?

• Худалдаанд байгаа химийн бодисууд нь үйлдвэрлэгчээсээ зөв хаяглагдсан байх шаардлагатай. Хэрэв хаяг нь урагдаж, гэмтсэн бол тухайн бодисыг өөр саванд шилжүүлэх эсвэл, шинэ уусмал найруулах зэрэгт шинэ хаяг наах шаардлагатай. Хортой бодисыг GHS ын дагуу зөв хаяглахад дараах мэдээллүүд багтсан байх шаардлагатай: таних үгс ба хортой аюулын ангилалын тэмдэг бүтээгдэхүүний нэр, химийн нэр, UN дугаар, хольц эрсдэл, анхны ба яаралтай тусламж үзүүлэх хэрэглэх заавар, "анхын ба яаралтай тусламж үзүүлэх заавар, аюулгүй ажиллагааны заавар" үйлдвэрлэгч болон нийлүүлэгчийн мэдээлэл баталгаат хугацаа ба MSDS Жич: дээрхи мэдээлэл нь 500мл эсвэл 500г аас дээш хэмжээтэй бодисын саван дээр байх ба түүнээс бага хэмжээтэй бол зарим мэдээллүүд хаяганд орохгүй байж болно

  Yes

  No

  N/A

• Тухайн бодисуудын MSDS ийг шалгаж, зөв бөгөөд хамт хадгалж болох бодистой нэг дор байгаа эсэхийг шалга. Шатамхай, исэлдүүлэгч болон хортой нэгдлүүд бусад бүх зүйлсээс тусдаа хадгалагдах ёстой. Хүчлүүд нь шүлт, цианид, гипохлоридоос тусдаа хадгалагдах ёстой. Исэлдүүлэгч хүчлүүд (нитрик эсвэл перхлорын г.м) нь шатамхай нэгдлүүдээс тусгаар байх ёстой

  Yes

  No

  N/A

• Бүх анхны тусламж үзүүлсэн тохиолдлууд нь компанийн Compliance Portal / Injury Reporting хэсэгт бүртгэгдэж явах ёстой, мөн бүх анхын тусламжийн тохиолдлууд нь тухайн салбарт бүртгэлтэй байх хэрэгтэй. Анхны тусламжийн бүртгэл нь анхны тусламжийн хайрцагны ойролцоо байдаг бол түүнийг анхны тусламж үзүүлэгчид шилжүүлэх хэрэгтэй ба анхны тусламж үзүүлэгч нь уг бүртгэлд юуг бүртгэх, юуг анхаарах талаар мэдээлэлтэй байна. Гэмтэл бэртлийг бүртгэхэд дараах зүйлс орно. Үүнд: осол болсон цаг, огноо ажлын байран дээр ямар нэг анхны тусламж авах шаардлагатай болсон хүнд тохиолдсон гэмтэл бэртэл, өвчин эмгэгийн талаархи мэдээлэл анхны тусламж үзүүлэгчийн гарын үсэг хийгдсэн тусламж ажилтан ажилдаа эргэж орсон, гэртээ харисан эсвэл эмнэлэг, эмч рүү явсан талаарх мэдээлэл

  Yes

  No

  N/A

• Хэрэв ямар нэгэн Ажлын Аюулгүй Байдал, Байгаль Орчны Дүн Шинжилгээ (JSEA), Аюулгүй Байдлын Таван Хором (Take 5) эсвэл эрсдэлийн үнэлгээ хийх шаардлага гарсан бол энэ сард хийсэн эсэх?

  Yes

  No

  N/A

• Ажлын Аюулгүй Байдал, Орчны Дүн Шинжилгээ (JSEA) хийгдсэн бол тэр нь стандартын дагуу хийгдсэн эсэх?

  Yes

  No

  N/A

• Ажлын Аюулгүй Байдал, Орчны Дүн Шинжилгээ (JSEA) хийх сургалтанд хамрагдсан бөгөөд хийгдсэн бол тэр нь стандартын дагуу хийгдсэн байх ёстой

  Yes

  No

  N/A

• ХАБЭАн нийцлийн шаардлагуудын дагуу бүх цахилгааны самбаруудыг 91.5 см (36 inch) зайд хязгаарлалтын шугам татсан эсэх?

  Yes

  No

  N/A

• Тоног төхөөрөмжүүдийн засвар үйлчилгээний бүртгэлүүдтэй бөгөөд байнга хөтөлдөг эсэх? Бутлуур, тээрэм, LM5ууд, тэргэнцэрүүд болон бусад тоног төхөөрөмжүүдэд зөвшөөрөлгүй хүрэхээс хамгаалалттай эсэх?

  Yes

  No

  N/A

• ALS группын үйл ажиллагааны дагуу цусан дахь хар тугалганы агууламжыг тодорхойлох хэмжилт заавал хийгдсэн байх ёстой. Нийт ажилчдын цусан дахь агууламж зөвшөөрөгдөх түвшнээс доогуур байгаа эсэх?

  Yes

  No

  N/A

• Ашиглагдаж байгаа химийн бодисуудын хор аюулуудыг тодорхойлсон MSDS уудын хэвлэмэл хуулбар гар доор ойрхон байгаа эсэх?

  Yes

  No

  N/A

Formulate Monthly Report

• This report is prepared soley of the purpose of a voluntary inspection. This document is protected from disclosure under relevant OHS or Environmental legislation

  Yes

  No

  N/A

• Line

  Yes

  No

  N/A

Item #

• NonCompliance Item

  Yes

  No

  N/A

• Compliance Note

• Comments and Action

• Responsible

  Yes

  No

  N/A

• Due Date

  Date

• Status

  Yes

  No

  N/A

• Action

  Yes

  No

  N/A

• Parts on order for minor repairs (eyewash covers)

  Yes

  No

  N/A

Monthly Progress Graphs

• Site:

• Date:

  Date

• Compliance (%):

• NonCompliances #:

• Potential

  Yes

  No

  N/A

• # of Compliances

  Yes

  No

  N/A

• % Compliance

  Yes

  No

  N/A

• General Safety

  Yes

  No

  N/A

• PPE

  Yes

  No

  N/A

• Hazardous Substances

  Yes

  No

  N/A

• Safety Equipment

  Yes

  No

  N/A

• First Aid

  Yes

  No

  N/A

• Fire Extinguishers

  Yes

  No

  N/A

• Safe System of Work

  Yes

  No

  N/A

• Emergency Evacuation

  Yes

  No

  N/A

• Working Environment

  Yes

  No

  N/A

• Manual Handling

  Yes

  No

  N/A

• Office Areas

  Yes

  No

  N/A

• Warehouse & Storage

  Yes

  No

  N/A

• Maintenance

  Yes

  No

  N/A

• Sample Preparation

  Yes

  No

  N/A

• Fire Assay

  Yes

  No

  N/A

• Compliance per Month

  Yes

  No

  N/A

• JANUARY

• FEBRUARY

  Yes

  No

  N/A

• MARCH

  Yes

  No

  N/A

• APRIL

  Yes

  No

  N/A

• MAY

  Yes

  No

  N/A

• JUNE

  Yes

  No

  N/A

• JULY

  Yes

  No

  N/A

• AUGUST

  Yes

  No

  N/A

• SEPTEMBER

  Yes

  No

  N/A

• OCTOBER

  Yes

  No

  N/A

• NOVEMBER

  Yes

  No

  N/A

• DECEMBER

  Yes

  No

  N/A

Quarterly Home

• Quarterly Inspection

  Yes

  No

  N/A

• Formulate Quarterly Inspection

  Yes

  No

  N/A

• Quarterly Progress Graphs

  Yes

  No

  N/A

Quarterly Audit

• Instructions for Use: This template Quarterly Inspection is designed for a "walk through" inspection. A number of HSE compliance criteria are applied to each section of the site. If a section is not relevant to your site, do not complete that section. In relevant sections, enter Y, N or NA as your answer. Your compliance rate will be automatically calculated based only on the questions answered Y or N. On completion, open the 'Formulate Monthly Report' sheet and click the 'Format List button'. A list of noncompliances will be automatically displayed. Complete the responsibilities and due date columns. As noncompliances are addressed, complete the status and action columns. The report is due the last Friday of every month and is to be posted on HSE Sharepoint where access is currently available before the end of the first week of the new month

• Site:

• Date:

  Date

• Conducted by:

• Compliance (%):

• NonCompliances #:

• 0 out of 0

  Yes

  No

  N/A

• Signoff:

• Line

  Yes

  No

  N/A

• Item #

  Yes

  No

  N/A

Site Area

• Compliance note

• Part 1 General Safety

  Yes

  No

  N/A

• Is there an adequate number of waste containers in the workplace?

  Yes

  No

  N/A

• Are there waste containers near every workstation/work area. Do employees need to walk through other workstations/work areas to access waste containers. Is there evidence of waste overflowing out of waste containers?

  Yes

  No

  N/A

• Are waste containers emptied when full?

  Yes

  No

  N/A

• Is there evidence of waste overflowing out of waste containers? Are containers that held Hazardous Waste labelled to prevent wrongful reuse?

  Yes

  No

  N/A

• Are safety signs prominently displayed e.g. First aid kit, fire extinguishers, radiation etc

  Yes

  No

  N/A

• Are floors dry and nonslippery?

  Yes

  No

  N/A

• Are floors free of tripping agents?

  Yes

  No

  N/A

• Are staff provided with the opportunity for consultation, their input and kept informed on HSE issues

  Yes

  No

  N/A

• This can be in a form of committees or Toolbox Talks

  Yes

  No

  N/A

• Does the site have a safety notice board displaying the group relevant HSE information?

  Yes

  No

  N/A

• Information to check for includes, but not limited to, Health and Safety Policy, Environmental Policy, Injury Management Policy, First Aid Officer details, Emergency evacuation warden details, Site specific emergency evacuation details, current safety alerts etc

• Does the site have a security system and is secure form unauthorised access during and after business hours?

  Yes

  No

  N/A

• Is electrical testing and tagging in place for electrical equipment and RCD’s and is it current?

  Yes

  No

  N/A

• Are records maintained for the disposal of hazardous waste?

  Yes

  No

  N/A

• Does the site have a waste water discharge agreement with the local water board, if so is it compliant with the agreement requirements?

  Yes

  No

  N/A

• Are site specific permits / licenses current?

  Yes

  No

  N/A

• i.e. Dangerous Goods, Concessional Sprits (Ethanol), Radiation Devices, AQIS

  Yes

  No

  N/A

• Does smoking only occur in designated areas?

  Yes

  No

  N/A

• Check for evidence of cigarette butts or ash in areas around the building

  Yes

  No

  N/A

• Is food and drinking restricted to lunch room and office areas

  Yes

  No

  N/A

• Check laboratory cupboards and fridges for food and drinks

  Yes

  No

  N/A

• Do the kitchen/lunchroom facilities appear to be clean, tidy and hygienic?

  Yes

  No

  N/A

• Are all electrical leads and required equipment tagged and tested?

  Yes

  No

  N/A

• Does smoking only occur in designated areas?

  Yes

  No

  N/A

• Check for evidence of cigarette butts or ash in areas around the building

  Yes

  No

  N/A

• Is food and drinking restricted to lunch room and office areas

  Yes

  No

  N/A

• Check laboratory cupboards and fridges for food and drinks

  Yes

  No

  N/A

• Part 2 Personal Protective Equipment

  Yes

  No

  N/A

• Are protective gloves available?

  Yes

  No

  N/A

• Protective gloves are available at all times in all areas

  Yes

  No

  N/A

• If yes, are they matched to the hazards involved?

  Yes

  No

  N/A

• Protective gloves available are suitable to be used for specific chemicals. Check MSDS in laboratory for specific chemicals in use and check if gloves being worn are appropriate

  Yes

  No

  N/A

• Are protective gloves being worn in the laboratory?

  Yes

  No

  N/A

• Are employees wearing protective gloves in the laboratory when completing tasks requiring this type of PPE?

  Yes

  No

  N/A

• Is eye protection available?

  Yes

  No

  N/A

• Eye protection is available at all times in the laboratory

  Yes

  No

  N/A

• Is there evidence that eye protection is being worn when required?

  Yes

  No

  N/A

• Are employees wearing eye protection in the laboratory when completing tasks requiring this type of PPE?

  Yes

  No

  N/A

• Are lab coats available?

  Yes

  No

  N/A

• Are lab coats available to employees required to wear them in the laboratory?

  Yes

  No

  N/A

• Are lab coats in use in the laboratory?

  Yes

  No

  N/A

• Are employees wearing lab coats when working in the laboratory?

  Yes

  No

  N/A

• Are staff wearing the appropriate PPE within specified areas

  Yes

  No

  N/A

• Are employees wearing the correct PPE within specified areas. Check mandatory PPE signage

  Yes

  No

  N/A

• Part 3 Hazardous Substances

  Yes

  No

  N/A

• Does the site have a hazardous substances register?

  Yes

  No

  N/A

• Check the chemicals that are available in the laboratory and storage areas and review that the signage is appropriate. For further information refer to the Guidance Note for Placarding Stores for Dangerous Goods and Specified Hazardous Substances

• Have hazardous substance risk assessments been completed for all hazardous substances?

  Yes

  No

  N/A

• Check that all hazardous subances have risk assessments completed in accordance with how the substances are used

  Yes

  No

  N/A

• Does the site have Materials Safety Data Sheets (MSDS) available for all employees and are they valid?

  Yes

  No

  N/A

• MSDS should be available for all employees to view when required. MSDS should not be more then 5 years old, and have an Australian emergency contact/supplier

  Yes

  No

  N/A

• Are all substances labelled clearly and correctly?

  Yes

  No

  N/A

• Commercially available chemicals should be appropriately labelled by the manufacturer. If a label is damaged, obscured, or chemicals are decanted into a new container or used to make a new solution, a new label is required. Hazardous substances are required by law to be labelled with the following information: signal word(s) and/or dangerous goods class label product name, chemical name, United Nations Number, ingredients risk phrases and safety phrases directions for use*, first aid procedures and emergency procedures* details of manufacturer or importer expiry date (where relevant)* and reference to MSDS Please Note: The above information is required by law on the label of any hazardous substance in a container of 500mL or 500g or larger. If the container is smaller that the asterisked(*) information can be omitted from the label. For further information refer to the National Code of Practice for the Labelling of Workplace Substances [NOHSC:2012(1994)]

• Are chemicals stored according to class and incompatibility?

  Yes

  No

  N/A

• Refer to the MSDS for the chemical to ensure it is stored correctly and away from any incompatible substances. Flammable substances must be isolated from all other substances. Oxidising substances must be isolated from all other substances. Toxic substances should be isolated from all other substances. Acids must be separated from alkalis, cyanides, hypochlorite. Oxidising acids (nitric & perchloric) must be separated from combustible and flammable materials/substances. For further information refer to the National Code of Practice for the Storage and Handling of Dangerous Goods [NOHSC:2012(2001)]

• Are signs in the laboratory and storage areas consistent with the hazards within?

  Yes

  No

  N/A

• Check the chemicals that are available in the laboratory and storage areas and review that the signage is appropriate. For further information refer to the Guidance Note for Placarding Stores for Dangerous Goods and Specified Hazardous Substances

• Part 4 Compressed Gasses

  Yes

  No

  N/A

• Gas lines, piping, manifold, etc, are clearly labelled with the identity of the contents

  Yes

  No

  N/A

• Hoses, tubing and regulators are in good working condition?

  Yes

  No

  N/A

• Part 5 Safety Equipment

  Yes

  No

  N/A

• Are safety showers in working order?

  Yes

  No

  N/A

• Ensure the following: access is unobstructed shower area is clean and free of debris flow from the shower head is adequate and continuous flow continues until deactivation water drains away freely

  Yes

  No

  N/A

• Are eye wash stations in good working order?

  Yes

  No

  N/A

• Ensure the following: access is unobstructed bowl and spouts are clean and free of debris flow from both eyepieces is adequate and continuous flow continues until deactivation water drains from bowl

  Yes

  No

  N/A

• Are spill kits available, well stocked and appropriate for the type of chemicals hazards?

  Yes

  No

  N/A

• Check that the spill kits are clearly marked and signage is in place

  Yes

  No

  N/A

• Part 6 First Aid

  Yes

  No

  N/A

• Is the first aid kit accessible?

  Yes

  No

  N/A

• Ensure the first aid kit is in a position where it is accessible to all rostered shifts and there are no obstructions

  Yes

  No

  N/A

• Is the location of the first aid kit clearly identified?

  Yes

  No

  N/A

• Ensure the first aid kit is clearly signposted and it is clearly identified with the appropriate sticker etc

  Yes

  No

  N/A

• Are all first aid treatments reported/recorded?

  Yes

  No

  N/A

• All first aid treatments are to be logged on the Compliance Portal / Injury Reporting. All treatment provided is to be recorded in this location as well. If there is a first aid treatment register with the first aid kit, this is to be removed with first aiders being instructed on where to record first aid treatment and requirements of what is to be recorded. Injury treatment information to be recorded includes: date and time of the incident a description of the incident / symptoms (in the works of the person seeking attention Signs observed by the first aider Treatment given whether the person returned to duty, went home, or was referred to a medical doctor or hospital

• Do all employees know where the first aid kit is located?

  Yes

  No

  N/A

• Question employees to ascertain their knowledge of where the first aid kit(s) is/are located. Check if employees are advised of this information during the induction process?

  Yes

  No

  N/A

• Is the name of the person responsible for the first aid kit clearly shown on a sign near the first aid kit?

  Yes

  No

  N/A

• It is necessary to assign this function to one person to ensure the first aid kits are maintained

  Yes

  No

  N/A

• Is the first aid kit complete, with no items past their use by date?

  Date

• Check what is required for the first aid kit and that it is complete. Check all items are not out of date?

  Date

• Is a telephone accessible and available close to the first aid area at all times?

  Yes

  No

  N/A

• This doesn't mean that there needs to be a telephone at the exact same location as the first aid kit. It is necessary that there is one in close proximity

  Yes

  No

  N/A

• Do employees know who their first aiders are?

  Yes

  No

  N/A

• Are there photographs of the first aiders on the HSE noticeboard. Question some employees to seek confirmation. This is important to question especially if there is a high turnover of staff

  Yes

  No

  N/A

• Have all personnel been advised of the procedure to be followed in the event of serious injury or accident?

  Yes

  No

  N/A

• Check training/induction records and ask employees

  Yes

  No

  N/A

• Have the appropriate number of people been trained in first aid?

  Yes

  No

  N/A

• Are the necessary first aid supplies available for site specific hazards such as Hydrofluoric Acid or Cyanide

  Yes

  No

  N/A

• Check for Calcium Gluconate gel, tables and ampoules for HF and Dicobalt Editate ampoules for Cn. Check the stock have not expired and the kits are clearly marked for their purpose

  Yes

  No

  N/A

• Part 7 Fire Extinguishers

  Yes

  No

  N/A

• Do all fire extinguishers have their accessibility maintained by a 1m clearly defined access way?

  Yes

  No

  N/A

• This is to provide a visual reminder to employees not to place items close to a fire extinguisher that may block access

  Yes

  No

  N/A

• Is there the number and type of fire extinguisher at the workplace sufficient?

  Yes

  No

  N/A

• Are the fire extinguishers clearly signposted?

  Yes

  No

  N/A

• Are fire detection devices, smoke alarms, sprinkler systems and lighted exit signs in good working order?

  Yes

  No

  N/A

• Part 8 Safe Systems of Work

  Yes

  No

  N/A

• If there has been a requirement to complete any Job Safety & Environmental Analyses (JSEA's), Take 5, or risk assessments, have any been completed in the last month?

  Yes

  No

  N/A

• If this has not been a requirement, please put NA in the Y/N section

  Yes

  No

  N/A

• Have the JSEA's that have been completed been in accordance with the required standard?

  Yes

  No

  N/A

• JSEA training has been completed. All completed JSEA's are required to be to the standard as outlined in the JSEA training

  Yes

  No

  N/A

• Part 9 Emergency Evacuation

  Yes

  No

  N/A

• Have all employees been made aware of the evacuation warning device? New starters within 2 days of commencing?

  Yes

  No

  N/A

• This can be checked by viewing induction records as well as questioning employees

  Yes

  No

  N/A

• Have all employees been made aware of what action they are required to take if the warning device sounds? New starters within 2 days of commencing

  Yes

  No

  N/A

• This can be checked by viewing induction records as well as questioning employees

  Yes

  No

  N/A

• Have all employees been advised of the designated emergency evacuation area? New starters within 2 days of commencing

  Yes

  No

  N/A

• This can be checked by viewing induction records as well as questioning employees

  Yes

  No

  N/A

• Have the evacuation warning devices been checked in the last 3 months?

  Yes

  No

  N/A

• Sight records of this check

  Yes

  No

  N/A

• Are all exits clearly marked?

  Yes

  No

  N/A

• Part 10 Working Environment

  Yes

  No

  N/A

• If required, has any occupational hygiene monitoring (personal monitoring) been carried out in the last month?

  Yes

  No

  N/A

• Occupational hygiene monitoring can include; noise monitoring, dust monitoring etc

  Yes

  No

  N/A

• If occupational hygiene monitoring has been carried out, were the results within the appropriate exposure standards

  Yes

  No

  N/A

• If you are unsure of what the exposure standards are for the contaminant monitored you can check the report supplied if monitoring was carried out by an external provider or you can refer to http://hsis.ascc.gov.au

• If the site has a cooling tower, has chemical dosing occurred in the cooling tower in line with manufacturers requirements?

  Yes

  No

  N/A

• Is chemical (dual biocide) dosing conducted as per manufacturers requirements?

  Yes

  No

  N/A

• Cooling tower servicing has monthly servicing carried out?

  Yes

  No

  N/A

• Is there monthly servicing of the cooling tower?

  Yes

  No

  N/A

• Cooling tower testing Has monthly testing of the cooling tower (total bacteria) been carried out?

  Yes

  No

  N/A

• Is there monthly testing of total bacteria?

  Yes

  No

  N/A

• Are all the results documented?

  Yes

  No

  N/A

• Are all results documented and filed for easy access?

  Yes

  No

  N/A

• Are the results within accepted limits?

  Yes

  No

  N/A

• Are the results within the acceptable limits?

  Yes

  No

  N/A

• If no, has this been followed up?

  Yes

  No

  N/A

• If the results were not within the acceptable limits, has an incident report been raised, appropriate people notified, dosing occurred and retested?

  Yes

  No

  N/A

• If extraction is required, is it sufficient for the contaminant?

  Yes

  No

  N/A

• If fume cupboards are in use, is testing carried out and up to date?

  Date

• Is lighting in the area fit for the task being carried out?

  Yes

  No

  N/A

• Part 11 Training

  Yes

  No

  N/A

• Have all employees completed scheduled safety training?

  Yes

  No

  N/A

• Is there a schedule in place for key training topics for the business? This includes induction, key hazard areas such as manual handling, chemical safety, lead safety, cyanide safety, spill training, emergency evacuation procedures, laboratory competence, first aid training, plant and equipment etc

  Yes

  No

  N/A

• Is there a PPE register which verifies that worker have received instruction in the use and maintenance of the PPE they are required to use?

  Yes

  No

  N/A

• If there have been new starters, did they receive their safety induction on the first day of employment?

  Yes

  No

  N/A

• Part 12 Manual Handling

  Yes

  No

  N/A

• Are correct manual handling procedures evident for lifting, carrying, overreaching?

  Yes

  No

  N/A

• Observe worker and include workers name in comments. Test for weight, good balance and grip, bend at knees and hips, load close to body, use legs to push bracing stomach and don't twist, move feet instead

• Part 13 Office Areas

  Yes

  No

  N/A

• Are workstations set up inline with ergonomic principles?

  Yes

  No

  N/A

• Check operators distance from the monitor, viewing distance should be 350mm to 750mm. Keyboard and mouse are positioned at a comfortable distance from the operator, adjustable five caster chair with adjustable backrest, leg room, operators upper legs and arms are parallel with the floor when seated

• Is office area free from trip hazards, are all drawers kept closed when not in use, are heavy items stored at lower levels?

  Yes

  No

  N/A

• Part 14 Warehouse / Storage

  Yes

  No

  N/A

• Are chemicals stored in bunded areas and according to class and compatibility?

  Yes

  No

  N/A

• For example: perchloric acid on a separate pallet to DIBK or acetone

  Yes

  No

  N/A

• Are the quantities of the stored chemicals kept to licencable/permitted limits?

  Yes

  No

  N/A

• Check what the permitted limits are if there are any

  Yes

  No

  N/A

• Are landings and passageways clear of obstructions for easy evacuation?

  Yes

  No

  N/A

• Transient storage areas must not block emergency exits or access to these exits

  Yes

  No

  N/A

• Check pallet racking. Are the beams free from any damage?

  Yes

  No

  N/A

• Check pallet racking. Is pallet racking bolted to the ground and Safe Work Load placarded?

  Yes

  No

  N/A

• Is pallet racking impact protection available where there is a risk of forklift or equipment collision?

  Yes

  No

  N/A

• Are items from head height to the top bay strapped or secured (as appropriate to the item being secured) within cage or bin or wrapped?

  Yes

  No

  N/A

• Check for over hanging materials

  Yes

  No

  N/A

• Are platform ladders in good condition and extension ladders prohibited from use for picking items?

  Yes

  No

  N/A

• Check feet, stability and condition of framework

  Yes

  No

  N/A

• If forklifts are used, are they inspected prior to use and maintained

  Yes

  No

  N/A

• Check record of inspections and check if there has been issues raised am maintenance carried out

  Yes

  No

  N/A

• Part 15 Maintenance

  Yes

  No

  N/A

• Are isolation & lockout procedures adhered to for equipment under repair or inspection?

  Yes

  No

  N/A

• E.g. use and understanding for danger tags and out of service tags

  Yes

  No

  N/A

• Is welding adequately controlled?

  Yes

  No

  N/A

• Check for welding shield adequacy and use. Check for separation of combustible materials. Oxy acetylene work to be carried by competent staff. A hot work procedure/permit must be in place. Are all welding hoses, gauges and flashback arrestors in operational condition, are electric welding leads in operations condition and properly connected, Is UV shielding adequate to protect other workers and visitors from 'flash' burns?

  Yes

  No

  N/A

• Is the site maintenance schedule in place and record up to date?

  Date

• Check to see if there is a site maintenance record and that it is current

  Yes

  No

  N/A

• Are tools appropriately guarded and protected with cut out switches?

  Yes

  No

  N/A

• Check saw benches etc

  Yes

  No

  N/A

• Are grinding operations performed in a screened off area to prevent spark injury?

  Yes

  No

  N/A

• Are work permit systems in place and records maintained i.e. Work at Heights Permits & Hot Works Permits

  Yes

  No

  N/A

• Check for records and question staff

  Yes

  No

  N/A

• Part 16 Security

  Yes

  No

  N/A

• Does the site have a security system and is secure form unauthorised access during and after business hours?

  Yes

  No

  N/A

• Part 17 Environment

  Yes

  No

  N/A

• Are records maintained for the disposal of hazardous waste?

  Yes

  No

  N/A

• Does the site have a waste water discharge agreement with the local water board, if so is it compliant with the agreement requirements?

  Yes

  No

  N/A

• Are site specific permits / licenses current?

  Yes

  No

  N/A

• i.e. Dangerous Goods, Concessional Sprits (Ethanol), Radiation Devices, AQIS

  Yes

  No

  N/A

• Part 18 Sample Preparation

  Yes

  No

  N/A

• Are staff wearing PPE within specified areas?

  Yes

  No

  N/A

• Check safety glasses, earmuffs, closed shoes, gloves, dust masks/respirators (minimum P2)

  Yes

  No

  N/A

• Has any personal dust monitoring been completed (this may include, total coal, dust or silica etc)

  Yes

  No

  N/A

• Has this been completed in the past month?

  Yes

  No

  N/A

• Has any ambient air monitoring been completed (Environmental Dust)?

  Yes

  No

  N/A

• Has this been completed in the last month and uploaded to sharepoint?

  Yes

  No

  N/A

• Has any noise monitoring been completed. This could be personal monitoring or spot checks?

  Yes

  No

  N/A

• Noise monitoring must be carried out upon commissioning of operations and any operational changes

  Yes

  No

  N/A

• Are energised pieces of plant and equipment (capable of inflicting bodily injury) appropriately controlled?

  Yes

  No

  N/A

• Check for cut out switches/ interlocks for RSD's, tumblers, guarding for crushers (belt drive guards for all crushers and feed guarding for rolls crushers), RSD's and drum tumblers and emergency stop buttons within easy reach of operator for all energised equipment

  Yes

  No

  N/A

• Are isolation & lockout procedures adhered to (eg for crusher, mills, LM5's, trolleys and other equipment)?

  Yes

  No

  N/A

• Use and understanding of out of service tags and danger tags

  Yes

  No

  N/A

• Are vacuums and dust extraction devices fully functional for operations where available?

  Yes

  No

  N/A

• Where total dust levels exceed the occupational exposure thresholds, dust must be controlled wither by extraction/other engineering options or supply of personal protective equipment. Extraction / engineering controls are preferred

• Are dust box procedures adhered to?

  Yes

  No

  N/A

• Examine dust box log and question various staff

  Yes

  No

  N/A

• Are ovens able to be opened from the inside in an emergency (where a worker may be entrapped)?

  Yes

  No

  N/A

• Is there an emergency shutdown switch inside the oven that also has an alarm mechanism when triggered? Is there a sign explaining the use of the emergency shutdown mechanism?

  Yes

  No

  N/A

• Are manual handling controls available to reduce manual handling risk?

  Yes

  No

  N/A

• List what controls are available and recommended controls. E.g. Puck lifters, Drum lifters, sample tipper bins, trolleys, trays, racking systems, crates with drop down sides, sorting tables at waist height, pallet adjusters, reduced sample load arrangements etc

• Are warning and safety signs clearly visible near equipment or hazards?

  Yes

  No

  N/A

• E.g. Mandatory PPE (respiratory, hearing, safety glasses etc), compressed air dangers, generic signs for energised equipment hazards)

  Yes

  No

  N/A

• Naturally occurring uranium samples are to be handled in accordance with operational procedures

  Yes

  No

  N/A

• Are samples scanned and identified as NORM for special handling above 1uSv/h for large batches and 5uSv/h for one off samples? Are records made of work times as applied to gamma radiation controls? Are alpha radiation controls in place for sample prep handling such as PPE, contamination monitoring, disposal and clean up procedures?

  Yes

  No

  N/A

• Are trip hazards controlled through adequate housekeeping?

  Yes

  No

  N/A

• E.g. power cords, hoses, air lines must not present a trip hazard. Sample crates and drums must be organised such that they do not present a trip hazard in the flow of pedestrian traffic

  Yes

  No

  N/A

• Is a maintenance record in place and up to date?

  Date

• Part 19 Fire Assay

  Yes

  No

  N/A

• Are litharge/flux/silver nitrate or other chemical containers labelled with hazardous substance safety information?

  Yes

  No

  N/A

• Are staff wearing the correct personal protective equipment and is personal protective equipment appropriately worn and maintained?

  Yes

  No

  N/A

• Check for issue of equipment on PPE register. Equipment must be signed for and instruction on use and maintenance provided. Fluxing up P2 dust mask or half face mask and impervious gloves, hammering out full face shield and forearm length leather rigging style gloves, handling hot tools/equipment full face shield, apron, heat resistant forearm length gloves, all tasks overalls and enclosed shoes. Workers must be clean shaven to allow appropriate PPE fit. Respiratory protection must be cleaned and stored in a sealed container for each worker when not in use

  Yes

  No

  N/A

• Personal dust monitoring (Total Dust, Lead and Uranium) complete?

  Yes

  No

  N/A

• Total dust, lead dust and uranium dust monitoring must be been completed upon commissioning of operations and upon any operational changes. Monitoring must be completed at least every 6 months unless it can be verified with continual monitoring the operations are consistent and without excessive variance at which time monitoring can be scheduled less frequently (e.g. 25 yearly)

  Yes

  No

  N/A

• Blood lead level monitoring complete?

  Yes

  No

  N/A

• Blood lead monitoring must be completed and documented in accordance with ALS procedures. Have all new employees had their baseline Pb within one month of starting?

  Yes

  No

  N/A

• Are appropriate hygiene practices adhered?

  Yes

  No

  N/A

• Check for wash up facilities available near by to fire assay with Dleading/metals specific soap. Check to ensure that hands, arms and face is washed before liquid or food consumption, that workers shower before finishing the shift, that clothes laundered onsite, that contaminated clothing is separated from noncontaminated clothing and that the shower area cleaned down regularly. It is recommended that a lead test kit is used to check for contamination in nonfire assay areas such as lunch rooms and keyboards

  Yes

  No

  N/A

• Is fire assay signage in place and in good order?

  Yes

  No

  N/A

• Check authorised only and lead risk area signs on entry to fire assay operations

  Yes

  No

  N/A

• Do staff have access to fresh water drinking facilities near by?

  Yes

  No

  N/A

• Is sweeping spilt flux/litharge in the fluxing up area prohibited?

  Yes

  No

  N/A

• Check for evidence of sweeping in this area. Workers must use either a dry vacuum method or wet sweep method. Sweeping permitted in hammering out and other areas provided that there is clear segregation of fluxing up and these other duties

  Yes

  No

  N/A

• Are fire assay induction procedures adhered to?

  Yes

  No

  N/A

• Check personal files for evidence that staff have been given training on fire assay hazards and have completed a fire assay hazards and safety test

  Yes

  No

  N/A

• Local exhaust ventilation systems (lead dust extraction) fully functional?

  Yes

  No

  N/A

• Check if current extraction adequately collects dust for fluxing up and collects vapours for the cupellation muffle. There should also be suitable heat extraction from the fire assay furnaces. A maintenance schedule should be kept to ensure effectiveness is monitored. If blood lead results for all workers raise at the same time, there may be issues with extraction

  Yes

  No

  N/A

• Are guards in place for tumblers, pot/crucible loaders, cupel loaders to prevent entanglement and/or exposure to excessive heat sources?

  Yes

  No

  N/A

• Are hardcopies of MSDS for chemicals used in the immediate vicinity located close by?

  Yes

  No

  N/A

• For example: litharge, flux, silver nitrate

  Yes

  No

  N/A

• Is a maintenance record in place and up to date?

  Date

• Check for maintenance of extraction systems, scrubber systems etc. Maintenance must be documented

  Yes

  No

  N/A

• Part 20 Other (Note: this section is to be completed if additional items need to be addressed)

Formulate Quarterly Report

• This report is prepared soley of the purpose of a voluntary inspection. This document is protected from disclosure under relevant OHS or Environmental legislation

  Yes

  No

  N/A

• Line

  Yes

  No

  N/A

Item #

• NonCompliance Item

  Yes

  No

  N/A

• Compliance Note

• Comments and Action

• Responsible

  Yes

  No

  N/A

• Due Date

  Date

• Status

  Yes

  No

  N/A

• Action

  Yes

  No

  N/A

Quarterly Progress Graph

• Site:

• Date:

  Date

• Compliance (%):

• NonCompliances #:

• 0 out of 0

  Yes

  No

  N/A

• Potential

  Yes

  No

  N/A

• # Compliances

  Yes

  No

  N/A

• % Compliance

  Yes

  No

  N/A

• General Safety

  Yes

  No

  N/A

• PPE

  Yes

  No

  N/A

• Hazardous Substances

  Yes

  No

  N/A

• Compressed Gases

  Yes

  No

  N/A

• Safety Equipment

  Yes

  No

  N/A

• First Aid

  Yes

  No

  N/A

• Fire Extinguishers

  Yes

  No

  N/A

• Safe System of Work

  Yes

  No

  N/A

• Emergency Evacuation

  Yes

  No

  N/A

• Working Environment

  Yes

  No

  N/A

• Training

  Yes

  No

  N/A

• Manual Handling

  Yes

  No

  N/A

• Office Areas

  Yes

  No

  N/A

• Warehouse & Storage

  Yes

  No

  N/A

• Maintenance

  Yes

  No

  N/A

• Security

  Yes

  No

  N/A

• Environment

  Yes

  No

  N/A

• Sample Preparation

  Yes

  No

  N/A

• Fire Assay

  Yes

  No

  N/A

• Compliance Per Month

  Yes

  No

  N/A

• JANUARY

• FEBRUARY

  Yes

  No

  N/A

• MARCH

  Yes

  No

  N/A

• APRIL

  Yes

  No

  N/A

• MAY

  Yes

  No

  N/A

• JUNE

  Yes

  No

  N/A

• JULY

  Yes

  No

  N/A

• AUGUST

  Yes

  No

  N/A

• SEPTEMBER

  Yes

  No

  N/A

• OCTOBER

  Yes

  No

  N/A

• NOVEMBER

  Yes

  No

  N/A

• DECEMBER

  Yes

  No

  N/A

Revision

• IN4.5.5.02.05

  Yes

  No

  N/A

• Date

  Date

• Version Number

Reason for Revision / Amendment

• Section Number

• Approved by (name & position title)

• Revised all questions and changed to monthly, quarterly and annual audits

  Yes

  No

  N/A

• All

  Yes

  No

  N/A

• Micheal Martin Group HSE Manager

  Yes

  No

  N/A

• New Document Number and Name, and deleted the audit section

• All

  Yes

  No

  N/A

• Micheal Martin Group HSE Manager

  Yes

  No

  N/A

Sheet