Information

  • Audit Title SR Number

  • Location
  • Inspection Date:

Crew/Contractor Information

  • Select the crew/s from the drop down box. Multiple selections can be made.

  • List the names of the crew/s

  • Are all personnel on site carrying their current CWW ID cards?

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Section 1.0 HSEQ Considerations

  • 1.1 Has the pre start JSEA been completed correctly with all risks identified? Has the JSEA been signed by all personnel on site? Please take a photo.

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  • 1.2 Have all controls identified on the JSEA been implemented appropriately?

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  • 1.3 Is the proper PPE being worn and in good condition? i.e. long long uniform, hard hats, safety glasses, vests, gloves, etc.

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  • 1.4 Is the AVDD unit being used for this task? If so, is the AVDD unit within calibration date?

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  • 1.5 Are the AVDD cables, earth leads and gloves in good condition? i.e. gloves not torn or have holes, cables do not have bare wires exposed or damaged insulation, earth leads dated and tagged.

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  • 1.6 Are the Main to Meter tickets current? Please take a photo.

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  • 1.7 Is there a first aid kit available and is it appropriately stocked for the activity being carried out?

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  • 1.8 Are all hazardous substances correctly labeled and stored correctly in spill trays?

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  • 1.9 is there a refuelling container available, is it fitted with a transfer nozzle and if a plastic fuel container, is it less than 5 years old? (date of manufacture is stamped on the bottom of plastic fuel containers)

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  • 1.10 Are gas offsets available? If planned or scheduled works, are DBYD plans available, including permits (if required by the DBYD plans)?

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  • 1.11 Is there a pipe locator available and was it used to locate services? Have all other services in the vicinity been located and marked to alleviate accidental strikes?

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Section 2.0: Traffic and Pedestrian Management

  • 2.1 Has the Traffic Management Risk Assessment been completed? Please take a photo.

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  • 2.2 Have all the listed controls that were identified in the risk assessment been appropriately implemented?

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  • 2.3 If the traffic management being provided by a third party, are their JSA'/SWMS and Plans completed and appropriate for the tasks being undertaken? Please take a photo.

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  • 2.4 Are the Traffic Qualifications held by the crew/s appropriate to the task and current, i.e. current and within the three year period? Take a photo of the ticket/s.

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  • 2.5 Is there appropriate Pedestrian/Traffic protection? Provide a photo of the set up.

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  • 2.6 Has the worksite been taped off to prevent unauthorised entry? Double taping is the minimum requirement.

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  • 2.7 Is there 'para webbing' available for use, if required, to prevent entry into the area?

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  • 2.8 Is the site housekeeping orderly with no tools, equipment or slip/trip hazards left on footpaths or public access areas?

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Section 3.0: Environmental Aspects

  • 3.1 Has the worksite been reinstated as per requirements and standards? i.e. clean up of driveways, gutters, nature strip, etc. Please take a photo.

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  • 3.2 Are silt traps correctly placed out to prevent excessive entry of contaminants into storm water drains?

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  • 3.3 Are all silt traps in good condition and able to be used? i.e not split.

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Section 4.0: Customer

  • 4.1 Prior to commencing the activity, have all considerations for customers been taken? i.e. blocked driveways, water off, customers notified (if required) while repairs are being taken.

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  • 4.2 During the task has the water main/service been kept free of contamination?

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  • 4.3 On completion of the task was the main, service, or hydrant flushed and or disinfected to ensure a clean supply?

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  • 4.4 Does the worksite require a specific clean up/disinfection due to a sewer spill etc.?

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  • 4.5 Has there been any damage caused to other assets or customers property?

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  • 4.6 If there are damages, have all the relevant details been recorded and reported? Please provide a photo of the damage and complete "Insurance report " and/or "Damage to other services report".

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  • 4.7 Have flanges/fittings etc. where required, e.g. planned or scheduled works, been checked for correct torque on bolts etc. with a tension wrench?

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  • 4.8 Has the task completion or progress been reported back to CWW? Ie. water off reported, job completed (Focus), damage, etc

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Section 5.0: Vehicles Plant and Equipment

  • 5.1 Are all vehicles and equipment in good working order, clean and presentable?

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  • 5.2 Are the correct tools/truck/crew being used for the task, i.e. no cross contamination due to a sewer spill carrying out a water task or vice versa?

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  • 5.3 Are vehicle and plant log books correctly filled out with any faults listed? Provide a photo of the log book/s.

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  • 5.4 Is there a fire extinguisher available, is it secured correctly and is it in service, i.e. been checked and tagged within the last 6 months, if the extinguisher was purchased within the last 6 months, sight the receipt of purchase.

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  • 5.5 Are the probes for locating services in good condition with insulated handles?

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  • 5.6 Is there a "sharps container and sharps grab tool" available?

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Section 10.0: M&E / Sewer

  • 10.1 Is the Wet Well clean and tidy as per procedures and requirements?

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  • 10.2 Are fall from heights barriers available and are they being used?

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  • 10.3 Is the area around the Well/Manhole clear of obstructions that would cause slips, trips or falls?

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  • 10.4 Are all Alarm Inhibit overrides been reset?

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  • 10.5 Are all covers correctly refitted and in proper condition?

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  • 10.6 Are log book details entered and station locked up?

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  • 10.7 Have all materials and rubbish been bagged and removed from the site, i.e. rags, old parts etc.?

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Section 12.0: Opportunities for Improvement

  • Are there any Opportunities for Improvement identified in the audit?

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  • Enter the details of the identified opportunities.

Section 13.0: Signatures and sign off.

  • Signature of Auditor/Supervisor/Manager

  • Signature of Additional Auditor/Supervisor/Manager

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.