Title Page

  • Client

  • Site Name

  • Conducted on

  • Prepared by

  • Location
  • Weather

Site Compound & Welfare Facilities

  • Site Compound appropriate to works being done.

  • Toilet Welfare Facility appropriate for site and kept in good order

  • Drying room adequate and with appropriate drying system

  • Canteen adequately equipped and kept clean for all

  • Site Storage area adequate for materials and kept in good safe accessible order

  • Site Housekeeping in Good Order (Clean As You Go Policy Being Adhered too)

Site Paperwork & Signage

  • Preliminary Plan on Site

  • Construction Stage Safety Plan on Site

  • AF1 & AF2 Displayed on Site

  • Safety Signage Displayed

  • Temporary Works Design Plan in Place (Where Applicable)

  • Temporary Works Sign Off Up to Date

  • Temporary Works Register on Site

  • Site signage erected and in good order

Falls from Heights

  • Scaffolding secured and fixed without risk

  • Scaffolding Design Plan

  • Scaffolding Secured and Fit for Purpose

  • Window Openings Secured with Fall Protection

  • Rooftop leading edges robustly secured

  • Stairwells Fall Protection inserted

  • Lift/Elevator Shafts Crash Deck/Fall Protection inserted

  • Ground Services Secured

  • Small Floor/Ground Openings Adequately Covered

  • Working at Heights Equipment Being Used Appropriately

  • Working at Height Equipment Safe and Fit for Purpose

Burial/Engulfment

  • Trenches adequately stepped back

  • Ground Service Openings adequately Monitored and Secured

  • Swamplands Monitored and Evaluated

  • Natural Open Ditches/Water Ways Monitored, Demarcated and Secured

  • Storm Drains Adequately Protected

  • Large Clay, Stone, Wood Stock Piles Secured and Monitored

  • Attenuation Tank Area Adequately Protected

  • Large Excavations/ Trenches Adequately Protected

Chemical/Biological

  • Adequate Measures in Place to prevent the spread of Covid-19

  • Crystalline Silica Protective Measures in Place and Being Adhered too

  • Lead Paint Protective Measures in Place and Being Adhered too

  • Asbestos Protective Measures in Place and Being Adhered too

  • Working in Confined Space Measures in Place and Being Adhered too (buddy system for Attic spaces etc)

  • Wood Dust Measures in Place and Being Adhered too

  • Aspergillosis measures in place and all guidelines being adhered too

  • Site dust containment measures in place and being adhered too

  • All Chemicals Secured in Bunds

Assembly/Dismantling of Heavy Prefabricated Components

  • Staircases Adequately Assembled and Inserted

  • RSJ’s Adequately Assembled and Inserted

  • Roof Trusses Adequately Assemble and Inserted to Plan

  • Prefabricated Concrete Floors/Walls Inserted to Plan

  • Robust Safe Plan of Action for the Demolition of Wall/Roof/Floor/Ceilings

  • All Works Being Carried out in Accordance to SPA/CoP

  • Props being used for Large Prefabricated Materials being Erected on Site

Working in Proximity of Live Services

  • Overhead Power lines Adequately demarcated & Goal Posts in Place

  • Underground Live Electrical Services Mapped

  • Internal Live Electrical Wiring Identified

  • Internal Live Electrical Wiring Isolation Tagout/Lockout System in Place

  • Working in Proximity to Live Gas Services Adequately & Safely Managed

  • Working in Proximity to Foul Services Adequately & Safely Managed

  • Working On or Near Pressurised Water Mains Adequately & Safely Managed

Adjacent Lands & Boundary

  • Adequate Site Fencing (Herras Fence/Wood/Metal Hoarding)

  • Site Boundary Fencing Secured & Monitored

  • Public & Site Pedestrian Management Plan in Place

  • Traffic Management Plan in Place and being used as proposed

  • All Neighbouring Lands Being Monitored

  • Neighbouring Lands Secured

Temporary Works

  • Scaffolding Design Plan

  • Civil Works Design Plan

  • Form Works Design Plan

  • Crane Base

  • Floor Props, False Works Platforms

  • One Off and/or Large Site Specific Signage

  • Sheet Piling/Ground Beam Bracing/Structure Bracing

  • Structure Support Scaffolding

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.