Origin Field Delivery - KCM Inspection ( Rev4 ) -Fall from Height or to a Depth ( Trench Collapse )

Origin Field Delivery - Fall from Heights ( to depth) could harm a worker. ( Rev 4)

• Origin Operations Area ( e.g. Combabula)

• Detailed Location

• Contractor:

• Conducted on

  Date

• Inspection Team

• Describe Task or Activity being conducted :

Origin Field Delivery - KCM Inspection - Worker could be harmed by falling from Height / to Depth ( Rev 4)

• Excavations have the correct benching or battering? <br><br><br>( A high score indicates excavations are correctly benched/ buttered. Workers can explain controls required prior to entering an excavation )

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Excavations have Barricading in place and Signage if required ? (Note - Not all project excavations require signage) <br><br><br><br>( A high score indicates barricading and signage is in place. Workers can explain barricading and signage requirements)

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Zone of influence controls in place ? ( Usually berms or bunds ) <br><br><br>( A high score indicates zone of influence controls are in place. Workers can explain what the zone of influence is and controls if required)

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• SWMS - Does it identify Fall from Height / to Depth hazards and offer suitable controls? <br><br><br>( A high score here indicates SWMS are correctly filled out , recently reviewed by the work team, all task risks included. Controls in SWMS are known by the work crew)

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Additional Controls listed for 'On the Job / On the day' risks ?<br><br><br>( A high score here indicates that job specific additional controls have been added to the start card or similar e.g. Hot Day = drink fluids)

  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><br>( A high score here indicates that workers can explain/ describe - Communication protocols, Emergency Contacts, on site First Aiders, Muster Points and location of emergency equipment e.g. First Aid Kits)

  Fully Effective

  Effective in Parts

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Work Team demonstrates knowledge of the Life-Saving Rules / CPB Safety Essentials and 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 assessed.

  Media

Contractor Representative

• Name:

• Role:

Origin Energy Representative

• Name:

• Role: