Title Page
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Site conducted
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Site address
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Complete Daily Pre-start using one or more of the following controls
- ESPM Pre-Start Check Including Risk Assessment & ToolBox
- Multiplex ToolBox Talk
- Multiplex Exclusion Zone Permit including Tool Box
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Conducted on
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Prepared by
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Job Number
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Weather (if working outdoors)
- Fine
- Showers
- Windy
- Storms
- Overcast
Hazards
Hazards (only select what is relevant to today)
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Traffic, pedestrians, EWPs & plant
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Select all relevant controls (at least one)
- Separate Work Activities
- Exclusion Zone
- Traffic Controllers
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Overhead / underground services
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Select all relevant controls (at least one)
- Competent Spotter Required
- Live services identified
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Hazardous substances
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Select all relevant controls (at least one)
- SDS in date (5 years) and risk assessed
- PPE to be worn
- Chemical Register
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Work at Heights
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Select all relevant controls (at least one)
- Edge protection
- Ladder access is fit for purpose and compliant
- Elevated Work Platforms
- Exclusion Zone (MPX permit required)
- Drop Zone marked
- Authorized Workers only
- Working at Heights Trained and Certified
- Direct Supervision
- Skilled and Competent Workers
- Fit to work including not fatigued
- No persons under materials being lifted
- Scaffolding fit for purpose
- Tools and Equipment fit for purpose
- Tools and Equipment Inspected prior to use
- Tools and Equipment Inspected as per manufacturer's instructions
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Repairs to existing / new roof
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Select all relevant controls (at least one)
- Safety Anchors in place
- Full body harness
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Manual Handling (large objects)
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Select all relevant controls (at least one)
- Manual Handing Equipment
- Team lifting
- Manual Handing Training
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Reversing on site
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Select all relevant controls (at least one)
- Spotter available
- Communication agreed
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Rain, fog, high winds
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Select all relevant controls (at least one)
- Monitor through day
- Re-assess after rain
Environment
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Contamination / leakage
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Select all relevant controls (at least one)
- Use spill kits and bunds
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Noise / vibration / community / heritage items
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Select all relevant controls (at least one)
- Identify service receptors
- Monitor noise & vibration
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Emergency preparedness
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Select all relevant controls (at least one)
- Location of First Aid Kit/room and Nurse Call Button
- Rescue Kit and Rescue KIt Trained
- Spill Kit and Response to spills trained
- All workers know the Assembly Point
- Emergency Response Plan and Diagram communicated
- Emergency Services and Contact numbers available
Checklist
Checklist
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Scope of works discussed with crew
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SWMS available
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Plant| Equipment Inspections is completed
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Emergency procedures available
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Incident Management Procedures known
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Materials received sign off received
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Prestart meeting completed
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Permits completed
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Qualifications, Training and Competency Verified
Permit to work
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Hot Works
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Exclusion zones
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Working at Heights
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High Risk Construction Works
Rescue Plan / Working at Heights Permit / Working alone
Rescue Plan / Working at Heights Permit
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Has a Rescue Plan been completed for this site and is it still current
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Are you working from EWPs or in Fall Arrest
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Please select what activity you are doing
- Using an EWP
- Working in fall arrest
Rescue Plan
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How accessible is the location in an emergency
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What are the access issues?
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Is there an issue with housekeeping or uneven ground
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What are the issues?
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How can workers communicate to people outside the work area in an emergency
- Verbal
- Phone
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How will the alarm be raised and by whom
- Verbal
- Phone
- By PIC
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Rescue & emergency personnel can access the workplace during night shift, weekends and holiday periods
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What kinds of emergencies are contemplated
- EWP failure
- Driver incapacitated
- Other
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If "Other" explain further
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If "EWP failure" select rescue options
- Lower EWP from ground controls
- Rescue from another EWP
- Other
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If "Other" explain further
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If "Driver incapacitated" select rescue options
- Lower EWP from ground controls
- Rescue from another EWP
- Other
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If "Other" explain further
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The provision of suitable rescue equipment will depend on the potential emergencies identified. Select type of rescue equipment needed to effect the rescue.
- EWP
- Gotcha Rescue Kit
- Spotter
- First Aid Kit
- Other
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If "Other" explain further
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Are the rescuers properly trained and sufficiently fit to carry out their task.
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Is appropriate First Aid available and someone trained to administer if required.
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How will local emergency services be notified of an incident.
- Call 000
- Call Site Foreman
- Call Site Supervisor
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Any other information emergency services need to know (plant in area, cranes, trenches, allergies)
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Supervisor / Person In Charge
Working at Height Permit
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Work location
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Supervisor / Person In Charge responsible for task
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Worker/s name/s undertaking the task
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Task description
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Plant & Equipment to be used
- EWP under 11m
- EWP over 11m
- Fall Restraint System
- Fall Arrest System
- Other
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Training and competencies to carry out works
- Working at Heights Training
- EWP Yellow Card
- High Risk Boom Ticket (WP)
Access /Egress
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Safe access to work areas for all employees in place
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Firm level ground for EWP / mobile access plant
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Overhead services have been identified & communicated or isolated
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Systems for the safe removal of waste materials are in place
Fall Prevention / Protection System
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Exclusion Zone established around work area
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An appropriate fall restraint / arrest system has been installed by suitably competent person
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An appropriate full body harness / lanyard / ropes have been selected and inspected for the task
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Tools and materials secured against falls
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Authorised by
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Issue Date
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Expiry Date
Working Alone
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Are there any isolated works or are you working alone
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What is the length of time the worker may be alone
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What time of day are they required to work alone
Potential Hazards
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Mobile phone contact is available at all times
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How will the alarm de raised in an emergency
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Designated contact times have been established with the office
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What is the time interval (in minutes)
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Will the emergency communication system work properly in all situations
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Is the work in a remote location that makes immediate rescue from emergency services difficult
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How will this be remedied
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What is likely to happen if there is a vehicle breakdown
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What machinery, tools and equipment may be used
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Are high risk activities involved
- Working at Heights
- Working near live services
- Working on or near mobile plant
- Demolition
- No high risk activities
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What controls are to be used
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Is fatigue likely to increase risk (eg: long driving hours)
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Is there an increased risk of violence or aggression when workers have to deal with clients or customers by themselves
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Can environmental factors affect the safety of the worker (exposure to hot or cold environments)
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What controls are in place for this
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Is there a risk of attack by animals - including reptiles, insects
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Does the worker have the required training for the works
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Can the worker able to make sound judgements about their own safety
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Are there any pre existing medical conditions that may increase risk
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Please list
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Reviewed by
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Does a manager need to be notified
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Have they been notified
Safe Work Method Statements (SWMS) | Safe Systems of Work such as SOPS or SWPs
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Any additional hazards and associated risks identified not covered in SWMS
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Use the Risk Matrix pictured to complete the Risk Assessment below for items not covered by the SWMS
Hazard
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What are the hazards and risks
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Risk Score before controls (refer to matrix)
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What controls will be implemented
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Risk score after controls in place (refer to matrix)
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Supervisor / Person In Charge
Acknowledgement and Signatures
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Attendee Acknowledgement:
NOTE: by signing below you agree to the following points:
1. I have read and understand this Daily Pre-Start|Tool Box|Work Plan and will work in accordance with the above
2. I will consult with the Supervisor / PIC if changes are required and assist in re-issuing this form if required.
3. I have been consulted on the specific safety and environmental requirements of the activity.
4. I understand that I am responsible for my own and fellow workers safety.
5. I have ticked the Fit 4 Work acknowledging that I am indeed fit for work and not affected by fatigue, alcohol or prescription or other drugs. -
Supervisor / Person In Charge
Attendee
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I am Fit 4 Work
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Name