ON-SITE SAFETY MANAGEMENT (TAILGATE) SHEET - ElectroNet Services

• Job Number

• Job Description

• What is to be Achieved

• Conducted on

  Date

• Prepared by

• Location
  Address

• INSTRUCTIONS
  
  1. Answer the questions below by typing in your responses. There are some items that will require you to choose from the
  2. To add a Corrective Measure click on the paperclip icon then ""Add Action"", provide a description, assign to a member, set priority, and due date.
  3. Complete audit by providing digital signature.
  4. Share your report by exporting as PDF, Word, Excel or Web Link.

COMPLETE SECTION BELOW BEFORE TRAVELLING TO SITE:

• Estimated Distance/Travel Time

• (km)

• (hrs)

• Rest Break(s) to be taken at (10 minutes every 2 hours):

• Potential Hazards & Controls (e.g. weather, road conditions)

• Driving to be Shared by: click "Add Name" button to enter name/s. You can add multiple times.

Name

• Repeat precautions on return trip.

HAZARD | Suggested Control : METHOD OF CONTROL IMPLEMENTED

• Shock Hazard | Isolate and test before work. :

• Use Of Ladders | Correctly foot and tie where appropriate. Don’t over extend or use top rungs. :

• Risk Of Trip | Maintain tidy area. :

• Personal Safety Equipment | Use correct equipment where appropriate :

• Public Safety | Use of barriers etc :

• Confined Areas (risk of heat, exhaustion, entrapment) | Regular Breaks Hydration Supplements/ Fluid Maintain good communication :

• Asbestos | Do visual check for any signs of asbestos. If in doubt – report and do not proceed. :

• Traffic | Use of cones/Traffic Management :

• Other not listed above?

  YES

  NO

• Click "Add Hazard" button to list and describe control method. You can add multiple times.

Hazard

• METHOD OF CONTROL IMPLEMENTED

PLANNING & EMERGENCY PREPAREDNESS

• Location of First Aid Kit, Rescue Ropes and Fire Extinguisher identified

  Yes

  No

• Visual Inspection of all tools and equipment to be used on this project has been undertaken

  Yes

  No

• Closest Emergency Contact Point: (consider the best course of action in an emergency)

• Cellphone Coverage:

  Yes

  No

• RT Coverage:

  Yes

  No

• Nearest Phone:

• ELECTRONET SERVICES CALLFREE ON 0800 768 9300

WORK PARTY DETAILS – (INCLUDING SUB CONTRACTORS):

• Click "Add Name and Signature" button. You can add multiple times.

Name and Signature

• Add signature

  Sign

• RESPONSIBILITY

• SITE SUPERVISOR: Name and Signature

  Sign