Title Page
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Site conducted
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Conducted on
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Inspected by
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Location
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Notification Number
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Work Order Description
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Plant ID Listed in Work Pack
Workplace Inspection
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MANDATORY - Provide Photo of Equipment ID (Emergency Stop, Conveyor Signage, Field Labelling).
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Have you cross referenced the physical equipment being worked on matches the intended equipment to be worked on as indicated in the work pack?
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Are all walkways, stairways & access/egress points clear from obstructions? E.g., temporary stored items, equipment.
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Is the area free of slip/trip hazards? E.g. no spillage, product build up or unlevelled ground?
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Are all items stored at an appropriate height? E.g., objects leaning against walls, stored at height, off balance?
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Are exit points readily accessible and free of obstructions in the event of an incident or evacuation?
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Is lighting in the area adequate for task being executed?
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Explain additional lighting requirements to be implemented for this task.
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Has all required barricading been set up before commencing the task?
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Explain why barricading has not been used for this task.
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Is there a high level of dust in the area?
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Are dust masks or suitable PPE readily available?
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Are there other work crews in the area and can all works be executed safely in conjunction with each other?
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Are isolations required to execute task?
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Explain why isolations are not required for this task.
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Have all required isolation points been identified and isolated?
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Have you confirmed a zero energy state?
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Explain how damaging energy risk is being controlled.
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How has zero energy state been confirmed?
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Infield Verification - A verification check that is performed by the work crew infield to verify that the
isolations locked onto match the equipment being worked on and is done by checking
infield labelling against isolations listed on their task specific isolation list or isolation
certificate, WIN or Isolation Procedure. -
Has the work party completed infield verifications of all isolations?
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Explain why infield verifications are not required for this task.
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I confirm that the Workplace inspection has been Inspected By (Signature) completed to an acceptable standard and in-line with the scheduled frequency. (Inspections are a legal requirement)
