Information
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Contract Name & Number:
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Conducted on
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Prepared by
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Add location
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Personnel
GENERAL
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A. Contract Management Plan (CMP) and appendices on site?
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B. Site Hazard ID completed and all controls in place?
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C. Daily Pre-Start Tailgate completed and all staff signed on including visitors and sub-Contractors?
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D. Staff and subbies clearly describe what was discussed at the prestart tailgate briefing
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E. Notifiable works
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F. Relevant SWMS / JSA's available on site
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G. Permits in place and been complied with (Dial B4 U Dig, Close Approach etc)
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H. Staff and Operators skill and competency appropriate for the tasks
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I. Operations are 4m clear of overhead lines at all times
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J. Seatbelts are being used on all plant
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K. Reverse parking
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L. First impression and general housekeeping
WORK AREAS
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A. Housekeeping and site maintenance is such that slips trips and falls is minimised
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B. Falls from unprotected edges, excavations and holes managed
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C. Impalement Hazards (Caps on Waratahs and Reinforcing bars)
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D. Spotters and safety observers clear of hazard zones
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E.. Sanitary Facilities available (drinking water and toilets etc)
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F. Material storage including stockpiles
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G. Low light conditions managed
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H. General public and motorists protected after hours
EMERGENCY MANAGEMENT, SIGNAGE AND COMMUNICATIONS
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A. Policies, Procedures, Newsletters, OFI forms, Values, Rules (eg Tikanga Safety Rules) displayed or available
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B. Communication, radio, cellphone coverage known
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C. Emergency Evacuation Assembly Points
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D. Emergency Contacts List
HEALTH AND FIRST AID
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A. Trained First Aiders
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B. First Aid Kits available and well stocked
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C. Sun protection available and used
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D. Declared health related issues communicated within the team (eg allergies, diabetes etc)
PERSONAL PROTECTIVE EQUIPMENT
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A. Compliant Hiviz vests and or clothing zipped up and in good condition
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B. Hard Hats
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C. Safety Glasses
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D. Face Shield / Goggles (If Required)
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E. Respiratory Protection (If Required)
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F. Hearing Protection (If required)
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G. Clothing - long sleeves and trousers
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H. Gloves
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I. Laced Steel Toe Caps
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J. Other
MANUAL HANDLING
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A. Manual handling risks identified and managed
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B. Mechanical aids used where available
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C. Workers able to operate in comfort
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D. Workers are not lifting heavy items frequently
FALL PROTECTION
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A. Trained Personnel (Competent Person)
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B. Harnesses correct fit and worn properly
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C. Suitable Anchor Points used
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D. Equipment inspected prior to use and within test
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E. Equipment stored properly (free from damage)
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F. Emergency Rescue Plan
LADDERS
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A. Proper type for task
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B. Rubber feet condition
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C. Rungs and stiles condition
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D. Positioned on flat stable foundation and secured at the top
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E. Extended 1m beyond top edge
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C. Other
TOOLS AND EQUIPMENT (non electrical)
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A. General Condition
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B. Proper type for task
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C. Other
EXCAVATIONS
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A. Dial B4 you dig completed when deeper than 300 mm and services marked out
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B. Shoring (trench shields) in place when deeper than 1.5m and or suitable batter or bench
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C. Access and Egress
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D. Soil Condition assessed
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E. Water Accumulating
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F. Barricades
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G. Spoil pile 1m from edge
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H. Air Monitoriing
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I. Emergency Rescue Plan
CONFINED SPACE
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A. Trained Personnel
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B. Process and Permit in place and followed
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C. Air Monitoring
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D. Emergency Rescue Plan
ELECTRICAL
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A. Condition of tools and equipment
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B. Extension Cords protected from damage,Tagged and in Test and RCD's used
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C. Power Tools Tagged and in Test
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D. Lock Out Tag Out process understood (fixed plant)
FIRE SAFETY
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A. Hot Work Permit (if required)
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B. Fire Watch Assigned (Competent Person)
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C. Fire Extinguisher within test
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D. Combustibles removed/isolated
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E. Hot Work Barricade (if required)
RIGGING AND HOISTING
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A. Tagged, inspected, certified and in good condition
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B. Suitable for the task (eg able to take the expected load)
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C. Permit in place (if required)
PLANT AND EQUIPMENT
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A. Daily Plant Checklists carried out
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B. Operator qualified, licensed and competent
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C. Reversing beeper, camera (where fitted), flashing beacon
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D. Safe working load displayed
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E. Operator Manual (for specialist plant)
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F. Guarding adequate and inplace
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G. Fire extinguisher and first aid kit
TRAFFIC MANAGEMENT
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A. TMP number and STMS noted on and Daily Pre-Start Sheet
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B. Approved TMP on site
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C. Set up correctly according to TMP and is it effective at controlling traffic and pedestrians
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D. Adequate separation between live traffic and work area
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E. Regular 2 hourly checks been carried out and signed off on Daily pre-start tailgate
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F. STMS and TC staff on site and certified trained
HSNO
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A. Staff trained (eg GrowSafe) for the products being handled and applied
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B. Restricted application areas and zones are known by applicators
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C. MSDS available for all chemicals and hazardous products
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D. Chemicals stored safely on site
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E. Proper PPE for Handling Chemicals
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F. Contaminated containers disposed of appropriatly
ENVIRONMENTAL
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A. Adequate Environmental Management Plan EMP on site
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B. Relevant resource consent conditions are understood and being complied with
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C. Heritage and culturally significant sites are clearly demarcated and known to all on site
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D. Habitats or species of conservation significance are not disturbed
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E. Vegetation clearance is kept to a minimum
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F. Dust suppression techniques are adequate and effective
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G. Approval has been given to discharge to waterways
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H. Sediment and run off control measures are adequate and effective
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I. Noise control measures are adequate and effective
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J. Spill kits appropriate type and size for the volume of products on site
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K. Chemicals and contaminates are stored safely and MSDS sheets readily available
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L. Waste and Energy minimisation measures are being followed
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M. Prescribed waste (asbestos etc) is being removed and disposed of responsibly
COMMENTS AND RECOMMENDATIONS
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Enter any corrective actions that will be undertaken
SIGN OFF
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Safety Representitive
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Site Supervisor
