Title Page
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Full Name:
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Conducted on:
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Prepared by:
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Site Address:
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INSTRUCTIONS
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1. Please answer "Pass," "Fail," or "N/A" on the questions below.
2. Add photos and notes by clicking on the paperclip icon
3. To add a Corrective Action click on the paperclip icon then "Add Action," provide a description, assign to a member, set priority, and due date
4. Complete audit by providing digital signature
5. Share your report by exporting as PDF, Word, Excel or Web Link
Other user details
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Title
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Email
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Mobile
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Manager
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User Location
General Details
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Job Reference Number:
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Job Description:
Section 1: Worksite Hazard ID
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Worksite Hazard ID completed
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Hazards identified and controlled
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Residual risk is rated C or below
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SWMS in use
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Evidence of Pre-start meeting undertaken
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Subcontractors on site signed on and implementing controls
Section 2: Worksite Competencies
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Drivers Licence current
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Operating Licences are current
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TC/STMS Card current
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Employee ID Card(s) current
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Competencies verified and current
Section 3: Personal Protective Equipment
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Head Protection: Climbing Helmet/Hard Hat worn when required
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Face Protection: Shield/Mask worn when required
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Ear Protection: Ear Muffs worn when required
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Eye Protection: Safety Glasses/Goggles worn when required
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Safety Footwear
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Hi-Viz Vest
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Gloves worn when required
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PPE being worn correctly
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All PPE compliant with applicable AS/NZS standard
Section 4: Authority/Permits to Work
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Authority Holder has correct ATW for high risk activity been performed
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Power - Close Approach Consents on site
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Corridor Access Request (CAR) on site
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Notifiable work - Work Safe contacted
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Permit to Work in place when required
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Gas - Close Approach Consent on site
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Outside MAD Close Approach Consent
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Approved Permit Issuer and or Receiver on site if permitted work been undertaken
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Work Authority Permit (WAP) on site
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Confined Spaces Entry Permit Issued
Section 5: Emergency Management
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Emergency assembly point established
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First aid kit present current
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Workers questioned and understand correct emergency procedures for their site
Section 6: Work Site Setup
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Vehicles parked safely
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Equipment positioned safely
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Van locked when out of site
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Approved Traffic Management Plan and site setup as per TMP
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General Site Housekeeping
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Work Area/Plant Isolated From Staff and Other Parties
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Site security in place and when unattended
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Site Set Out According To Job Start
Section 7: Environment
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Relevant permissions/consents in place
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Spill kits present where required
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Sediment controls in place
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Environmental risks managed as detailed in SWMS
Section 8: Underground/Overhead Services
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Service plans are current and maintained on site
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Approved tools in use
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Correct colour coding has being used by locator
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Services have been potholed
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Spotters used where required
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MAD Maintained
Section 9: Hazardous Materials
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Hazardous Materials on Site labelled, sealed, stored and used correctly
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Safety Data Sheets on Site
Section 10: Vehicles and Plant
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Pre-start complete for relevant plant/equipment
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Vehicles/plant in good condition
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Fire extinguisher tested and tagged
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Mobile Plant or Scaffolding Earthed
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Trucks and trailers chocked on obvious sloped ground
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Vehicles/plant suitable for tasks undertaken
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Equipment calibration current
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Vehicles/plant have current RUC, CoF, WoF,Rego
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Spill kit available on truck
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Electrical test and tag
SECTION 11: Audit Sign Off
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Overall rating if this site
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Auditor's Name & Signature:
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Auditee's Name & Signature:
