Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • UEA Crew Name or Subcontractor

  • Job Number

Mandatory Pre-start Requirements

  • Daily HAC or JSEA completed

  • Mandatory PPE as defined by SWMS being worn by personnel

General Site Safety

  • Drop Zones defined and marked with witches hats

  • Appropriate Traffic and Pedestrian Management in place supplemented with Traffic / Pedestrian Management Plan

  • Appropriate signage in place defining pedestrian and traffic access around work site

Supply Authority Mandatory Requirements

  • LV Rescue and / or Pole Top Rescue Kit checked and in place as required

EWP & Equipment

  • Daily inspection of EWP and equipment completed and record exists.

  • Operators reversing are looking in direction of travel. Operators slow down or stop in places where pedestrians could be. Plant is driven safely (walking pace)

  • Mobile phones not used whilst operating any plant.

Work at Heights

  • Ladders are not used to work from when a person could fall 1.8 metres or more (eg, like next to penetrations) unless 1 metre back from edge for every 1 metre of height on the ladder.

  • People are not stepping above third highest rung and have 3 points of contact (2 feet and one hand, or 2 hands and 1 foot) during going up or coming down the ladder.

  • Person on ladders is carrying tools and equipment in a belt or bag or use a hand lanyard.

  • Builders or extension ladders are securely fixed at top.

  • Pole top rescue kit in place for work above 2m

Work Near Overhead Power Lines

  • Minimum distance is maintained to overhead powerlines. Voltage up to 132kV - min 3m, 132 to 330kV - min 6m, Greater than 330kV - min 8m. Advisory stickers in Plant.

  • An observer is used for all work near overhead power lines.

SMR Crew Assessment

  • Tasks allocated and identified as per roles and responsibilites

  • Coloured brims assigned as per work roles

  • Communication channels established and adequate

  • Daily role rotations established

  • Has the NOSMR drawings been drawn corectly

  • Is the attitude of all crew members adequate and suitable for a successful team performance

  • Is the use of mobile phones restricted to company use and break time unless in case of emergency

  • Are Non electrically qualified workers ensuring they are out of clearances whilst service is strung

SMR Groundie

  • No other tasks to be done while watching EWP Operator

  • Communicating well with EWP Operator

  • Worksite kept clean and footpaths kept clear

  • Controls dropzone and immediate worksite

  • Can groundworker clearly demonstrate current overhead work principles?

Network Worker

  • Is Network worker ensuring enough time is allowed for site set up prior to starting each job. I.e running out cables etcI

  • Is network worker ensuring they position themselves in suitable location to minimise time lost due to repositioning

  • Was a Pre Work inspection on the structure performed prior to working aloft?

  • Rubber mats installed on any conductors and earthed situations within clearances

  • Services raised and tensioned to approved procedures and standards

  • Safe working practices adhered to? Eg. Control of tails, live work practices

POA Workers

  • Are POA workers ensuring workload is not shed to groundsmen unless necessary

  • Pole top rescue kit in place for work above 2m

  • Ladders lashed at top to POA

  • Harness worn when working over 2m

  • Visual conformation of phase rotation meter where applicable

  • Pole strap used to appropriate fixing point when working over 2m

Environment

  • Worksite clean up after work has been completed

Lifting

  • Comments and Corrective Actions

  • Auditor Signature

  • Crew Leader 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.