Surveillance Report Information
OHS Worksite Surveillance Report
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Job Number
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Address / Reference Number
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Client
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Date
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Inspected By:
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Location
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Team Name
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Non Conformances that are (H = High Risk) must be acted on as soon as possible.
(M = Medium Risk) actions can be programmed for rectification.
OHS Controls
1. OHS Controls
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1.1 Staff and Contractors have Work Cover Card and Drivers Licence- Rating High
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Comment / Actions Taken and Date
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1.2 Staff and Contractors have inducted to Site or signed into Building - Rating Medium
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Comment / Actions Taken and Date
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1.3 Visitor Log Book Signed. (Buildings) - Rating Medium
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Comment / Actions Taken and Date
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1.4 SWMA, SWMS and Safety Folder available on site - Rating High
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Comment / Actions Taken and Date
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1.5 all Site Specific Hazards have been Identified and Controlled - Rating High
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Comment / Actions Taken and Date
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1.6 On Larger Projects are Toolbox Talks available - Rating Medium
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Comment / Actions Taken and Date
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1.7 On Larger Projects Site Specific OHS Management Plan Onsite - Rating Medium
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Comment / Actions Taken and Date
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1.8 Emergency Contacts Onsite -Rating Medium
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Comment / Actions Taken and Date
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1.9 PPE available and being used -Rating High
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Comment / Actions Taken and Date
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1.10 First Aid Kit Class B for up to 25 Staff. See checklist in Safety Folder Section 8 - Rating High
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Comment / Actions Taken and Date
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1.11 Sharps Kit Contents Onsite -Rating High
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Comment / Actions Taken and Date
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1.12 Vehicle and Plant Hazard Lights On -Rating Medium
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Comment / Actions Taken and Date
Traffic Controls
2. Traffic Controls
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2.1 Traffic Plan is Available Onsite - Rating Medium
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Comments / Action Taken and Date - Rating Medium
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2.2 Traffic Plan Scenarios
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Comments / Action Taken and Date
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2.3 Does Traffic Plan adequately control Pedestrians and Vehicles - Rating High
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Comments / Action Taken and Date
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2.4 Traffic Plan Evacuation Points - Rating High
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Comments / Action Taken and Date
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2.5 Traffic Controllers have Tickets Onsite -Rating Medium
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Comments / Action Taken and Date
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2.6 Traffic Controllers wearing PPE - Rating Medium
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Comments / Action Taken and Date
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2.7 Traffic Controllers using appropriate Signage -Rating Medium
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Comments / Action Taken and Date
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2.8 Are Staff regularly inspecting traffic control setup - Rating Medium
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Comments / Action Taken and Date
Environmental Controls
3. Environmental Controls
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3.1 CCTS Chemical Matrix Onsite -Rating Medium
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Comments / Action Taken and Date
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3.2 Spill Kits Onsite (Heavy Vehicles and Plant) - Rating High
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Comments / Action Taken and Date
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3.3 Erosion and Sediment Controls in place - Rating High
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Comments / Action Taken and Date
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3.4 Dust Controls (Refer to Dust SWMS) -Rating Medium
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Comments / Action Taken and Date
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3.5 Noise Controlled (Refer to Noise SWMS) -Rating Medium
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Comments / Action Taken and Date
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3.6 Weekly Vehicle Checks Completed - Rating Medium
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Comments / Action Taken and Date
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3.7 Daily Plant Checks Completed - Rating High
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Comments / Action Taken and Date
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3.8 Loads Covered to prevent spillage - Rating High
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Comments / Action Taken and Date
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3.9 Site Clear of Waste, Rubbish and Debris - Rating High
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Comments / Action Taken and Date
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3.10 Environmental Checklist Completed - Rating High
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Comments / Action Taken and Date
Work Standards
4. Work Standards
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4.1 Materials and Tools used as specified - Rating Medium
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Comments / Action Taken and Date
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4.2 Job Pack, Instructions Onsite - Rating Medium
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Comments / Action Taken and Date
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4.3 Job As Built Information Accurate - Rating High
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Comments / Action Taken and Date
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4.4 Construction to Specifications - Ratings High
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Comments / Action Taken and Date
Work Standards Technical
4. Work Standards -Technical
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4.5 Site Log Book Signed -Rating Medium
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Comment / Action Taken and Date
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4.6 Contractor ID Valid and on display - Rating Medium
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Comment / Action Taken and Date
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4.7 Contractors Telstra Site Induction Certification Number available Onsite - Rating Medium
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Comment / Action Taken and Date
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4.8 Contract Product Quality and OHS Plan Onsite -Rating Medium
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Comment / Action Taken and Date
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4.9 Contract / Product Risk Assessment Plan Onsite - Rating High
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Comment / Action Taken and Date
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4.10 Hard Copy of Detailed Design Onsite - Rating High
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Comment / Action Taken and Date
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4.11 Work Instructions Available - Rating Medium
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Comment / Action Taken and Date
Others
5. Others
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Others
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Others
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Rating
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Conforms, Non Conforms, N/A
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Comments / Action Taken and Date