P & E FRANCIS PLANT HIRE - JSA

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Pole Number

• Add location
  Address

Working at Heights

• Fall risk of 1.5m or more?

  Safe

  At Risk

  N/A

• Is edge protected?

  Yes

  No

  N/A

Plant and Equipment

• Unsafe or damaged plant?

  Safe

  At Risk

  N/A

• Incorrect plant / equipment for job?

  Safe

  At Risk

  N/A

• Is flasing light operational?

  Yes

  No

  N/A

• Travel alarms working correctly?

  Yes

  No

  N/A

• Operators trained in safe operation of equipment?

  Yes

  No

  N/A

• Plant is greased and in good working order?

  Yes

  No

  N/A

• Daily pre start checklist is completed?

  Yes

  No

  N/A

Hazardous Manual Tasks

• Hazardous manual tasks are identified and assessed?

  Safe

  At Risk

  N/A

• Are controls adequate?

  Safe

  At Risk

  N/A

• Are operators trained in correct lifting techniques?

  Yes

  No

  N/A

Hazardous Chemicals ( including fuel and oil )

• Are MSDS accessible and current?

  Yes

  No

  N/A

• Are chemicals stored in safe manner?

  Yes

  No

  N/A

• Is the spill containment kit adequate?

  Yes

  No

  N/A

• Are operators trained in spill response?

  Yes

  No

  N/A

• Are fire extinguishers tagged and in date?

  Yes

  No

  N/A

Emergency Response

• Have workers completed Esitrain Energex training program?

  Yes

  No

  N/A

• Are emergency plans for site discussed in pre start?

  Yes

  No

  N/A

• Is the first aid kit fully stocked?

  Yes

  No

  N/A

• Is first aid accessible?

  Yes

  No

  N/A

Traffic Management Plans

• Is there a TMP in place?

  Yes

  No

  N/A

• Are the TMP controls adequate?

  Safe

  At Risk

  N/A

• Are all on site, including visitors, aware of and trained in TMP?

  Yes

  No

  N/A

• Is truck parked in a safe area and barricaded for safety?

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Is all PPE being worn or used?

  Yes

  No

  N/A

• Is PPE being used as designed?

  Yes

  No

  N/A

• Is PPE adequate for the task?

  Yes

  No

  N/A

• Are operators trained in the correct use of PPE.

  Yes

  No

  N/A

Work Environment

• Is there sufficient work lighting?

  Yes

  No

  N/A

• Is the work area clean and free of rubbish?

  Yes

  No

  N/A

• Do work tools create trip hazards?

  Safe

  At Risk

  N/A

• Do pedestrians pose a hazard?

  Safe

  At Risk

  N/A

Electrical Hazards

• Are there underground assets in work area?

  Yes

  No

  N/A

• Is there a risk of contact with underground assets?

  Safe

  At Risk

  N/A

• Are there overhead electrical lines?

  Yes

  No

  N/A

• Is the a risk of contact with overhead wires?

  Safe

  At Risk

  N/A

• Is there RCD protection on electrical equipment?

  Yes

  No

  N/A

• Are electrical leads placed on the ground or metal structures?

  Yes

  No

  N/A

• Is electrical equipment being used near water?

  Yes

  No

  N/A

• Is electrical equipment being used near flammables?

  Yes

  No

  N/A

• Are the LOTO procedures adequate?

  Yes

  No

  N/A

Environmental Hazards

• Is there an EMP ( environmental management plan )?

  Yes

  No

  N/A

• Is the adequate dust suppression?

  Yes

  No

  N/A

• Is water being re-used where possible?

  Yes

  No

  N/A

Administrative Procedures

• Does the work request have all required information?

  Yes

  No

  N/A

• Have all permits been obtained?

  Yes

  No

  N/A

• Are all on site inducted?

  Yes

  No

  N/A

• Is there adequate supervisory arrangements?

  Yes

  No

  N/A

• Are there adequate SWMS for the task?

  Yes

  No

  N/A

• Are there systems to review SWMS as required?

  Yes

  No

  N/A

• Is there adequate routine monitoring and auditing?

  Yes

  No

  N/A

• Is the safety portfolio up to date and current with WHS laws?

  Yes

  No

  N/A

Quality Assurance

• Is the correct pole being replaced?

  Yes

  No

  N/A

• Is the excavation completed within the required timeframe?

  Yes

  No

  N/A

• Are all safety procedures and barriers in place?

  Yes

  No

  N/A

• Is the excavation to the required dimensions?

  Yes

  No

  N/A

• Were the public notified about intention to excavate where required?

  Yes

  No

  N/A

Corrective Action

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