QPRC HSR Inspection Form

Health & Safety Representative Site Inspection Form

• This inspection form is to be used by Health and Safety Representatives to conduct safety inspections in accordance with WHS Operational Risk Management Process.

  

• Instructions:
  -------------------------------------
  1. Start the inspection by taking a photo of the Site being Inspected.
  2. Answer each item as "Yes", "No", "N/A".
  3. Add photos and notes by clicking on the paperclip icon.
  4. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
  5. Complete audit by providing digital signature.
  6. Share your report by exporting as PDF, Word, Excel or Web Link.
  
  Note: Take photos of any noted issues or damage.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Reason for Inspection

  Routine Inspection

  Incident

  New Site

• C1834446, Version 1.1, Issue Date: 04/04/18 This is a controlled document. Unless otherwise shown, printed or downloaded versions of this document are uncontrolled..

Previous Inspections and Raised Actions

• Has an Inspection been carried out on this area previously?

  Yes

  No

  N/A

• How many Actions were raised from the last inspection?

  Yes

  No

  N/A

• List all actions that have been previously raised, and if they have been closed off satisfactorily?

  Yes

  No

  N/A

HSR Site Inspection

• Project No.

• CARS No:

• Site Name:

• Take photo of work site .

  Media

• Are all personnel inducted onto site?

  Yes

  No

  N/A

• Emergency procedures in place and understood by all staff?

  Yes

  No

  N/A

• Site Safety Rules displayed and/ or are available at site van or crew vehicle?

  Yes

  No

  N/A

• Work Site Specific Risk Assessment Form completed and available for inspection? <br>Attach photo of completed Risk Assessment.

  Yes

  No

  N/A

• Appropriate barricading, fencing in place to protect public (if required)?

  Yes

  No

  N/A

Random check of certificates

• Are there special certifications required onsite (i.e. Pool Lifeguard, Whitecard etc.)?

  Yes

  No

  N/A

• WHS Induction Card (Attach photo evidence of card)

  Yes

  No

  N/A

• Authorized Traffic Controller (Attach photo evidence of card)

  Yes

  No

  N/A

• Plant/ Drivers Licence (Attach photo evidence of card)

  Yes

  No

  N/A

• Other (Pool Life Guard etc). (Attach photo evidence of card or qualification)

  Yes

  No

  N/A

• Site specific Safe Work Method Statements available on-site?<br>(Attach photographic evidence)

  Safe

  At Risk

  N/A

• Site specific Safe Operating Procedures available onsite?<br>(Attach photographic evidence)

  Safe

  At Risk

  N/A

Tasks being performed have:

• Tasks being performed have a Safe Work Method Statement (SWMS)?

  Yes

  No

  N/A

• SWMS and Number?

  Yes

  No

  N/A

• Are these being complied with?

  Yes

  No

  N/A

• Tasks being performed have a Standard Operating Procedure (SOP)?

  Yes

  No

  N/A

• SOP and Number?

  Yes

  No

  N/A

• Are these being complied with?

  Yes

  No

  N/A

• All personnel wearing Safety Equipment as per SWMS/ SOP?

  Safe

  At Risk

  N/A

• Specific Site Safety Data Sheets for substances being used are available onsite and are within 5 years old?

  Yes

  No

  N/A

• Bunding and containment provided to all chemical storage and refuelling areas is in satisfactory condition?

  Yes

  No

  N/A

• Traffic Control Plan (TCP) implemented and available onsite?<br>TCP No.?

  Yes

  No

  N/A

• TCP set up and inspections being undertaken daily?

  Yes

  No

  N/A

• TCP implemented- signage, sight & distances?

  Yes

  No

  N/A

• Work area free of rubbish, amenities clean and in good order?

  Yes

  No

  N/A

• Are waste streams separated into appropriate bins prior to disposal?

  Yes

  No

  N/A

• Is there plant being operated onsite?

  Yes

  No

  N/A

Random check of Plant Operators pre-start checklist?

Random Plant Operators name and Plant Number (Attach photographic evidence and comment on quality)

• Random Plant Operators Name and Plant Number (Attach photographic evidence and comment on quality)

• Plant and equipment in good visual condition?

  Yes

  No

  N/A

• Warning lights operational on appropriate machinery?

  Yes

  No

  N/A

• Reversing alarms operational on appropriate machinery?

  Yes

  No

  N/A

• Are Fire Extinguishers fixed to plant and in test date?

  Yes

  No

  N/A

• Is there a Stockpile onsite?

  Yes

  No

  N/A
• Stockpile location
  Address

• Stockpile location and control measures in place.<br>(Attach photos of controls in place)

  Yes

  No

  N/A

• All excavations comply- e.g. banks battered correctly, spoil away from edges?

  Yes

  No

  N/A

• Stockpile sites are appropriately placed and materials stored safely?

  Yes

  No

  N/A

• All disturbed areas have erosion and sediment control measures in place?

  Yes

  No

  N/A

• Work site erosion and sediment control measures effective?

  Yes

  No

  N/A

• Plant Parking areas located appropriately and away from trees and watercourses?

  Yes

  No

  N/A

• Dust from construction site minimised?

  Yes

  No

  N/A

• Noise from site is not intrusive on any adjacent properties?

  Yes

  No

  N/A

• Vehicle turning points are available and have Advanced Warning signs in place?

  Yes

  No

  N/A

First Aid

• Is the First Aid room in a clean and serviceable condition, with all equipment in date?

  Yes

  No

  N/A

• First Aid Kit available onsite and in date?

  Yes

  No

  N/A

• Trained First Aider onsite?<br>(Photo of First Aider)

  Yes

  No

  N/A

• Is there a serviceable stretcher available?

  Yes

  No

  N/A

Extinguishers

• Are all extinguishers onsite in test date (checked within last 7 months)?

  Yes

  No

  N/A

• Are electrical items being used on the job site currently Tested and Tagged?

  Yes

  No

  N/A

• Site Manager

  Sign

• HSR

  Sign