Origin CSG Projects - KCM Inspection - Mobile Plant Interaction could harm a worker

KCM Inspection - Harm from Mobile Plant (Rev3)

• Origin Operations Area: ( i.e. Combabula)

• Detailed Location:

• Contractor:

• Conducted on

  Date

• Inspection Team

• Describe Task or Activity being Conducted:

KCM Inspection - Harm from Mobile Plant

• Traffic Management Plan is in place and effective?<br><br>( A high score here indicates an effective TMP- workers could explain TMP requirements & how they are implemented )

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Plant/ traffic signage in place and effective?<br><br>( A high score here indicates clear signage with correctly named operator and barricades in place. Team can explain access to Plant Operation Zone)

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Evidence of positive communications for traffic matters?<br><br>( A high score indicates positive communication = when both parties participate - the work team can explain when Positive Communication is required)

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Only trained and competent persons operate mobile equipment?<br><br>(A high score here indicates workers have the correct training/licence for the work being undertaken- workers could explain the training and/or VOC process as it applies to the task being undertaken)

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• SWMS/JSA identify mobile plant risks and offer suitable controls?<br><br>( A high score indicates SWMS/JSA are correctly filled out, recently reviewed by work team, all task risks included. Controls identified in SWMS/JSA are in place & known by work crew .)

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Additional Controls for ' On the Job / On the Day' risks ?<br><br>( A high score here indicates additional controls are listed in permits and/or Job Start Cards. E.g. Hot Day= Drink fluids. Workers can explain why additional controls have been implemented)

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Work team has the ability to effectively respond to an emergency ? <br><br>( A high score here indicates workers could explain/describe - Communication, Emergency Contacts, First Aiders and First Aid kits, Muster Points etc)

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Can the work team demonstrate knowledge of the Origin Lifesaving Rules & the application of those to the task at hand?<br><br>( A high score here indicates the team know the specific lifesaving rules that apply to the task.

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

Additional Comments

• Comments

• Photo of Task being performed

  Media

Contractor Representative

• Role:

• Signature

  Sign

Origin Energy Representative

• Role:

• Signature:

  Sign