Title Page
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Project/Works
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Conducted on
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Prepared by
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Location
Hazards, Controls and Precautions Identification
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Project Manager/Council Representative must indicate which hazards may be applicable to specific contract works
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Hazards identified for this contract
- Asbestos/Lead
- Chemical Exposure
- Confined Space
- Compressed Air/Pressure/Vacuum
- Electrical
- Falling Object
- Fire/Explosion
- Gas/Fumes
- Heat Source
- Machine Guarding
- Manual Handling/Ergonomics
- Mobile Plant
- Moving Machinery
- Noise
- Poor Housekeeping
- Poor Lighting
- Restricted Access
- Services Underground/Overhead Hazard
- Soil Contamination
- Sun, UV, Rain, Wind
- Traffic/Pedestrians
- Trenching/Excavation
- Uneven Slippery Surface
- Welding
- Working at Heights
- Working in Isolation
- Working Over Pit/Hole
- Not Applicable
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Project Manager/Council Representative must identify the specific controls to address the hazards as identified above
PPE
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Identify any controls or precautions that relate to PPE
- Head Wear (Sun Hat, Hard Hat, Welding Helmet)
- Eye Wear (sun glasses, safety glasses, goggles, face shield)
- Hearing Protection
- Respirator / Mask
- Wet Weather Gear
- Gloves (safety, chemical, heavy duty, riggers)
- Safety Harness
- Spill Containment Kit
- Safety Boots
- Clothing (long sleeved shirt, trousers, overalls)
- High Visibility Vest
- Not Applicable
Plant and Equipment
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Identify any controls or precautions that relate to Plant and Equipment
- Scaffold
- Ladder
- Forklift / Forklift Work Box
- SDS
- Elevated Work Platform
- Not Applicable
Physical Isolations
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Identify any controls or precautions that relate to physical isolations
- Traffic Management
- Electrical
- Gas
- Water
- Hydraulic
- Pneumatic
- Barricading
- Not Applicable
Licences and Permits
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The Project Manager/Council Representative must identify the licences and permits that the Contractor must have to undertake the works identified
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Licence/Permit Details for this Contract Include
- Asbestos Awareness and Identification
- Asbestos Removal Licence - Class A
- Asbestos Removal Licence - Class B
- Builders Licence
- Cert III Arboriculture
- Cert IV Aroboriculture
- Chainsaw Operation and Maintenance
- Confined Space Training
- Dangerous Goods Licence
- DBYD Locator Accreditation
- Diploma Arboriculture
- Dozer (Class LZ)
- Emergency Plans
- Excavator (Class LE)
- Fire Prevention Plan
- First Aid
- Front End Loader (Class LL)
- Front End Loader Skid Steer (Class LS)
- Front End Loader/Backhoe (Class LB)
- Full Pest Management Technicians Licence
- High Risk Licence - Crane and Hoist Operations
- High Risk Licence - Dogging and Rigging Work
- High Risk Licence - Elevated Work Platform - Above 11m
- High Risk Licence - Forklift
- High Risk Licence - Mobile Crane Operations
- High Risk Licence - Scaffolding Work
- Accreditation and Memberships to Relevant Industry Peak Bodies
- Limited Pest Management Technicians Licence
- Pest Control Licence
- Mobile Elevated Work Platform Training Evidence
- Safe Operating Procedure for Plant
- Operators Vehicle Licence
- Hazardous Chemical Register
- Prepare and Apply Chemicals - Control Pest, Weeds and Diseases
- Q-Fever Vaccination
- Hepatitis B Vaccination
- Hepatitis A Vaccination
- Sample Traffic Management Plan
- SWMS - Working at Heights above 2m
- Transport and Store Chemicals
- Use Standard Climbing Techniques to Access Trees
- Working Safely at Heights
- Working safely near live electrical apparatus as a non electrical worker
- Working safely near asbestos materials
- Workzone Traffic Management
- Not Applicable
Additional licence requirements
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Identify any additional licence and permit requirements not listed previously
Project Manager/Council Representative Sign Off
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Signature
