Title Page
Details
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Date and Time
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Employee Name
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Site Name Location
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Task Description
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Vehicle Type
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Vehicle Registration
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is the employee licensed for this type of and vehicle and is the license current?
Personal Protective Equipment
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Eye Protection
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Hand Protection/ Gloves
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Steel Capped Footwear
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Long Sleeves and Long Leg Clothing
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Hi Visibility Clothing or Vest (Vic Road Standard)
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UV Protection - Broad Brimmed Hats, Sun Cream
Traffic Management and or Site Protection Measures
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Flashing Lights Operational
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Hazard Warning LIghts Operational
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Site Has Advanced Warning Signs
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Site Has Been Barricaded (cones, barrier tape)
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Traffic Management Measures Employed
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Traffic Management Plans Available
Working Environment
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Housekeeping Adequate
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Load Secured
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Daily Plant Checklist Completed
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First Aid Kit Available and Fully Stocked (no expired items)
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Other items to be included in the audit
Tools And Equipment
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Hand Tools Appear in Good Condition
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Warning Stickers In Place And In Good Condition
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Powered Plant In Good Condition
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Warning Lights Operational
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Guarding In Place
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Lifting Equipment are Tagged, And In Good Condition
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Fire Extinguishers Fitted And Testing Current (within the green zone)
Documentation / Risk Assessment
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Are Standard Operational Procedures Available and Understood
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Are Safe Work Method Statements Available And Understood
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Site Specific Risk Assessments Performed
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Safety Data Sheets Readily Available For All Chemicals Being Used
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All Chemicals In Approved Containers
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Has Employee Been Trained On The Plant And Equipment
Observations And Comments
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Comments and Observations
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Follow up Inspection Required
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Followed Up Audit Due On - Insert date
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Auditors Signiture