Title Page

  • Project Name

  • Location
  • Onsite Principal Contractor(s)

  • Conducted on

  • Prepared by

  • Any member of the Development Team visiting the site may complete this form. Please provide further comment where a hazard is observed during this site visit; if necessary a corrective action may be raised from findings

  • Note: NA- can include not applicable and / or not seen at the time of visit

  • 1. Has site fencing been established; does it appear to be maintained? (e.g. intact, not falling or crushed by shrubbery)

  • 2. Is signage in place for the following:

  • Emergency Assembly point?

  • First Aid (including contact information)?

  • Construction Signage (PC Contact information including a/hours)?

  • No trespassing?

  • Site Office, Amenities including directional signage, where required?

  • 3. Are all workers wearing hi-vis , hard hats and safety boots

  • 4. Is work occurring in areas with inadequate lighting?

  • 5. Are solid barriers installed around open or exposed edges? (e.g. edge of deck, floors, holes, formwork, elevator shafts)

  • 6. Are access ways and walk areas clear of rubbish/materials

  • 7. Are plant (e.g. forklift, cranes) operational zones and people on the ground separated ?

  • 8. Are there protruding objects not easily seen that could cause a trip hazard?

  • 9. Do all fixed scaffolds have a scafftag current within 30 days

  • 10. Do all scaffolds have adequate edge protection? (E.g. handrails/mid-rails/toe boards)

  • 11. Mobile scaffolds are on firm even ground?

  • 12. Are workers standing on the top rung of aluminum or step ladders or leaning off work benches?

  • 13. Are EWP’s (Scissor lift) used with gates closed and not moved whilst platform is extended

  • 14. EWP (boom) operators are secured with a harness

  • 15. Are there sharp edges not protected? (E.g. reinforced bar ends or tie wire)

  • 16. Are electrical tools are tested and tagged in current period?

  • 17. Are electrical leads lying on the floor?

  • 18. Is there any SERIOUS and IMMINENT Risks? Discuss with WHS

  • Close down work area until rectified:

  • Issued By:

  • Role:

  • Signature of issuer:

  • Issued To:

  • Company:

  • Signature:

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