Title Page

  • Division:

  • Auditor:

  • Audit Number: (HSEQ only)

  • Date:

  • Customer/Client/Contract:

  • Location
  • Job No:

  • Job Description:

  • Critical Risk Activities to consider

  • Personnel on site:
  • Name:

  • Role:

  • Signed onto JSEA:

  • Competency for Task:

Audit Element

  • Work is approved/authorized

  • Scope of work understood and maintained

  • PCBU's consulted at shared site

  • Hazard controls implemented and maintained

  • Emergency preparation documented

  • Site control effective-cones, signs, sign in register

  • Public protection controls effective

  • Risk assessment completed (JSEA)

  • FA Kit/Fire Extinguisher/Spill Kit available

  • PPE used correctly

  • Site tidiness

  • Ladders positioned safely

  • Permits if applicable

  • Traffic Management Plan if applicable

  • Vehicles and plant inspected

  • Plant used safely- EWP

  • Vehicle information pack available

  • Electrical leads and tools/appliances test tagged

  • Meters/Test equipment tested and labeled

  • Tools and equipment used safely

  • Hazardous Substances management-SDS

  • Subcontractor management completed

  • Quality of work inspected

  • Test records completed

  • As built/As installed correct

  • Testing compliant to AS/NZS3000, AS/NZ3760

  • Covid-19 site management ( as applicable)

Summary of audit discussion with personnel on site:

  • Summary of audit discussion:

Sign Off

    Sign Off
  • Auditee Name:

  • Auditee signature

  • Auditor signature

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