Title Page

  • Document No.

  • Subtitle

  • Conducted on

  • Client :

  • Prepared by

  • Location
  • Personnel Attending

  • Subcontractor Company

  • Activity

Site Access/Safety Station (tick as required()

  • Are the site contacts current and displayed?

  • Is the emergency plan current & displayed including the designated assemble areas?

  • Is there a current Vehicle Management Plan (VMP) available?

  • Fire extinguishers, first aid kits available?

Risk Management

Risk Management

  • Is the current JSEA on site and all workers have signed on and clearly understand the risks/controls?

  • Have the crew completed a site specific pre-start and is located at location of works?

  • Have all workers in the crew signed on to the site specific pre-start?

  • Can workers demonstrate the above the line controls for high risk activities e.g. people vs plant - provide an example?

  • Ias there a current & up to date Traffic Management Plan (TMP) in place?

  • Is there a need for a qualified STMS on site - if so check his qualifications and write his # down?

  • Are permits current and in place for high risk works e.g. Dig permit, Hot Works, Close Approach?

General Site Observations

General Site Observations

  • Are amenities clean and tidy, clean drinking water, hand sanitisers available, portaloos cleaned on a regular basis?

  • Are personnel undertaking good ergonomic practices; not over stretching or twisting body

  • 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

  • Additional PPE available for specialised activities e.g. Double eye protection for cutting or grinding, chaps etc.

  • Are tools and equipment in good condition, no cracked handles, if not tag out and remove from site immediately?

  • Are all electrical tools/equipment, leads, RCD devices being used currently tested and tagged by a competent person?

  • Are all leads off the ground and not causing a potential trip hazard?

  • Is the lifting equipment displaying a current test/tag?

  • Are harnesses/lanyards tested and tagged, showing no signs of deterioration and stored safely when not in use?

  • Workers understand the reporting protocols?

Plant/Equipment/Vehicles

Plant/Equipment/Vehicles

  • Do operators have valid licenses, e.g. Full drivers licence, WTR endorsed? Photo required.

  • Have operators completed a daily plant pre-checklist prior to operating the plant/equipment?

  • Have you observed operators, drivers of light vehicles and passengers wearing seatbelts in moving vehicles?

  • Is the plant/equipment displaying a Plant Inspection sticker?

  • Are vehicles parked safely e.g. not on a decline?

  • Are exclusion zones set up to protect people from plant e.g. Plant Operating Zone (POZ)?

Environment

Environment

  • Sediment controls in place and effective?

  • Spill kits available?

  • Is dust and noise being managed?

  • Are hazardous substances stored safely in bunded trays and containers labelled correctly?

  • Are the Safety Data Sheets available and current (within 5 years) and are crews aware of the control measures?

  • 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.

  • Permits not in place e.g Working at Heights, B4UDig, Confined Spaces, Hot Works etc.

  • Add media

  • Work Training Competencies - If any certificates are out of date or crew are undertaking work for which they hold no valid training qualification

  • Add media

  • Traffic Management Plan not being followed / members of the public safety at risk

  • Add media

  • Breach of JSEA or Safe Operating Procedures

  • Add media

  • Unsafe behaviour/act/conditions e.g. Horseplay, operating faulty machinery, disobeying site rules

Action/Recommendations

Any other Actions/Recommendations

Positive Behaviours Identified

Sign Off

  • Site Representative Agreed Actions

  • Add signature

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.