Title Page
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Document No.
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Subtitle
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Conducted on
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Client :
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Prepared by
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Location
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Personnel Attending
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Subcontractor Company
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Activity
Site Access/Safety Station (tick as required()
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Are the site contacts current and displayed?
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Is the emergency plan current & displayed including the designated assemble areas?
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Is there a current Vehicle Management Plan (VMP) available?
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Fire extinguishers, first aid kits available?
Risk Management
Risk Management
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Is the current JSEA on site and all workers have signed on and clearly understand the risks/controls?
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Have the crew completed a site specific pre-start and is located at location of works?
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Have all workers in the crew signed on to the site specific pre-start?
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Can workers demonstrate the above the line controls for high risk activities e.g. people vs plant - provide an example?
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Ias there a current & up to date Traffic Management Plan (TMP) in place?
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Is there a need for a qualified STMS on site - if so check his qualifications and write his # down?
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Are permits current and in place for high risk works e.g. Dig permit, Hot Works, Close Approach?
General Site Observations
General Site Observations
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Are amenities clean and tidy, clean drinking water, hand sanitisers available, portaloos cleaned on a regular basis?
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Are personnel undertaking good ergonomic practices; not over stretching or twisting body
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Personnel wearing the minimum personal protective equipment/clothing e.g. Hard hat;safety lace up boots:safety eyewear;long pants and long sleeve shirts, clean and zipped up orange hi-vis vest (unless STMS) and carrying gloves for manual activity tasks
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Additional PPE available for specialised activities e.g. Double eye protection for cutting or grinding, chaps etc.
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Are tools and equipment in good condition, no cracked handles, if not tag out and remove from site immediately?
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Are all electrical tools/equipment, leads, RCD devices being used currently tested and tagged by a competent person?
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Are all leads off the ground and not causing a potential trip hazard?
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Is the lifting equipment displaying a current test/tag?
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Are harnesses/lanyards tested and tagged, showing no signs of deterioration and stored safely when not in use?
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Workers understand the reporting protocols?
Plant/Equipment/Vehicles
Plant/Equipment/Vehicles
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Do operators have valid licenses, e.g. Full drivers licence, WTR endorsed? Photo required.
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Have operators completed a daily plant pre-checklist prior to operating the plant/equipment?
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Have you observed operators, drivers of light vehicles and passengers wearing seatbelts in moving vehicles?
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Is the plant/equipment displaying a Plant Inspection sticker?
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Are vehicles parked safely e.g. not on a decline?
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Are exclusion zones set up to protect people from plant e.g. Plant Operating Zone (POZ)?
Environment
Environment
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Sediment controls in place and effective?
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Spill kits available?
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Is dust and noise being managed?
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Are hazardous substances stored safely in bunded trays and containers labelled correctly?
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Are the Safety Data Sheets available and current (within 5 years) and are crews aware of the control measures?
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Are sediment ponds/exavations retaining water visible to the public fenced and signage displayed?
Critical Risk Non-Compliance
If any of the following safety critical areas are not compliant then work must stop until the issue is resolved. Please provide non-compliance brief description and how you mitigated the risk to prevent recurrence.
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Permits not in place e.g Working at Heights, B4UDig, Confined Spaces, Hot Works etc.
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Add media
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Work Training Competencies - If any certificates are out of date or crew are undertaking work for which they hold no valid training qualification
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Add media
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Traffic Management Plan not being followed / members of the public safety at risk
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Add media
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Breach of JSEA or Safe Operating Procedures
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Add media
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Unsafe behaviour/act/conditions e.g. Horseplay, operating faulty machinery, disobeying site rules
Action/Recommendations
Any other Actions/Recommendations
Positive Behaviours Identified
Sign Off
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Site Representative Agreed Actions
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Add signature
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Add signature