• Prepared by

  • Conducted on

  • Location of Works

  • Name of Contractor

  • Service Request Number

  • This Inspection Report is intended for use by employees to ensure contractors are meeting OH&S requirements and undertaking works in accordance with current industry standards.

  • Type of Work

  • Description of Works

  • Current Weather Conditions

Occupational Health and Safety

  • Has a JSEA/SWMS been completed with all associated risks identified?

  • Has the JSEA/SWMS been signed by all personnel at the site?

  • Are all personnel on site carrying appropriate licences for the tasks being performed?

  • Has a DBYD/MOCS enquiry been made to identify all other services in the vicinity of the works? (Planned works)

  • Is the appropriate PPE being worn for the activities being undertaken?

  • Is the PPE in proper condition and being worn correctly?

  • Are correct manual handling techniques being used by all personnel on site?

  • Is there a sufficiently stocked First-Aid kit available on site?

  • Is an Abnormal Voltage Detection Device (AVDD) being used for this task?

  • Is the AVDD being used correctly and is it within the required calibration period?

  • Please enter the calibration/service date and unit identification number.

  • Comments

Traffic and Pedestrian Management

  • Is appropriate traffic and pedestrian management being implemented?

  • Is a copy of the Traffic Management Plan available on site?

  • Has the worksite been isolated (e.g. Para-webbing, barriers) to protect the public and prevent unauthorized entry?

  • Are all safety signs and equipment being used in good condition?

  • Comments

Confined Space Entry

  • Does this activity involve Confined Space Entry (CSE)?

  • Have Confined Space Entry permits been obtained and filled out correctly?

  • Do all personnel performing the Confined Space Entry have the appropriate training and licenses?

  • Has the Operational Control Centre (OCC) been notified of the Confined Space Entry?

  • Is the Confined Space Entry being undertaken as per the Confined Space Entry Plan?

  • Is a copy of 'Confined Space Entry & Associated Work Procedures' (PRO-69) available/accessible on site?

  • Is all PPE being used for the Confined Space Entry in service and in proper condition for its use?

  • Comments

Vehicles, Plant and Equipment

  • Are all vehicles, plant and equipment clean and in good working order?

  • Are vehicle and plant log-books correctly filled out and up to date?

  • Does all plant and equipment have the required safety mechanisms and silencing tools in place?

  • Is there an 'in-service' Fire-Extinguisher available on site?

  • Comments

Asbestos Tasks

  • Is asbestos removal or repairs involved in this task?

  • Is the contractor suitably licensed (e.g. Class B licence) to undertake asbestos related activities?

  • Has an Asbestos Plan been completed and a Supervisor nominated?

  • Are all personnel involved in the task appropriately trained and certified to carry out asbestos related tasks?

  • Is the appropriate PPE for asbestos related tasks being worn by all workers on site?

  • Is the appropriate signage being displayed correctly on site?

  • Has all waste been removed as per current industry standards (i.e. double-bagged with SR number written on outer bag)?

  • Comments

Environmental Aspects

  • Are silt traps in place to prevent excessive sediment entry into storm water drains?

  • Are measures in place to protect Flora and Fauna from being damaged as a result of works?

  • Are all hazardous substances and/or dangerous goods stored safely on site and correctly labelled?

  • Are MSDS's available and/or accessible to workers on site?

  • Are waste stockpiles watered down to prevent excessive dust and contaminants from entering the atmosphere?

  • Comments

Customer Focus

  • Have customers been given the required notification of the activities being undertaken?

  • Has the water supply been shut down?

  • Please enter the time that water was called off.

  • Is the contractor aware of the timeframe for water supply interruptions (i.e. 146 minutes)?

  • Has there been any consequential damage caused to customers property or other assets?

  • If damage has been caused, have all of the relevant details been recorded and reported?

  • Comments


  • Is the excavation size appropriate for the activities being undertaken?

  • Is the correct equipment being used for the excavation?

  • Is the excavation greater than 1.5m in depth?

  • Has the contractor sent a notification to commence trenching to WorkSafe?

  • Are proper shoring devices safely in place?

  • Is backfilling and compaction being undertaken in accordance with council/VicRoads requirements?

  • Comments

Mechanical and Electrical - Sewer

  • Has the wet-well and site been cleaned as per standard procedures?

  • Are all covers correctly re-fitted and in good condition?

  • Are 'fall from heights' barriers and protection measures in place?

  • Are all alarm inhibit over-rides reset?

  • Are log-book details entered and station locked up?

  • Comments

Opportunity for Improvement

  • Were any opportunities for improvement identified during this inspection?

  • Please enter details below and ensure they are recorded, reported and followed up.

Sign off

  • Auditor's Signature

  • Once you have selected 'Finish' below, please export this document via email to

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.